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Schulze N, Werpy N, Gernhardt J, Fritsch G, Hildebrandt T, Vanderperren K, Klopfleisch R, Ben Romdhane R, Lischer C, Ehrle A. Dynamic three-dimensional computed tomographic imaging facilitates evaluation of the equine cervical articular process joint in motion. Equine Vet J 2023; 55:83-91. [PMID: 35043993 DOI: 10.1111/evj.13560] [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: 07/19/2021] [Revised: 11/08/2021] [Accepted: 12/30/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Dynamic computed tomography (CT) imaging has been introduced in human orthopaedics and is continuing to gain popularity. With dynamic CT, video sequences of anatomical structures can be evaluated in motion. OBJECTIVES To investigate the feasibility of dynamic CT for diagnostic imaging of the equine cervical articular process joints (APJs) and to give a detailed description of the APJ movement pattern. STUDY DESIGN Descriptive cadaver imaging. METHODS Cervical specimens of twelve Warmblood horses were included. A custom-made motorised testing device was used to position and manipulate the neck specimens and perform dynamic 2D and 3D CT imaging. Images were obtained with a 320-detector-row CT scanner with a 160 mm wide-area (2D) solid-state detector design that allows image acquisition of a volumetric axial length of 160 mm without moving the CT couch. Dynamic videos were acquired and divided into four phases of movement. Three blinded observers used a subjective scale of 1 (excellent) to 4 (poor) to grade the overall image quality in each phases of motion cycle. RESULTS With an overall median score of 1 the image quality, a significantly lower score was observed in the dynamic 3D videos over the four phases by the three observers compared with the 2D videos for both flexion (3D 95% CI: 1-2 and 2D 95% CI: 1-3; P = .007) and extension movement (3D 95% CI: 1-2 and 2D 95% CI: 1-3; P = .008). Median Translational displacement of the APJ surface was significantly greater in flexion than in extension movement (P = .002). MAIN LIMITATIONS The small number of specimens included. Excision of spines and removal of musculature. CONCLUSIONS The study is a first step in the investigation of the potential of dynamic 3D CT in veterinary medicine, a technique that has only begun to be explored and leaves much room for refinement prior to its introduction in routine practice. CT with a detector coverage of 16 cm and a rotation speed of 0.32 seconds provides high-quality images of moving objects and gives new insight into the movement pattern of equine cervical APJs.
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Affiliation(s)
- Nicole Schulze
- Equine Clinic, Surgery and Radiology, Freie Universität Berlin, Berlin, Germany
| | - Natasha Werpy
- Equine Diagnostic Imaging Inc., Archer, Florida, USA
| | - Jennifer Gernhardt
- Equine Clinic, Surgery and Radiology, Freie Universität Berlin, Berlin, Germany
| | - Guido Fritsch
- Leibniz Institute for Zoo and Wildlife Research, Forschungsverbund Berlin e.V., Berlin, Germany
| | - Thomas Hildebrandt
- Leibniz Institute for Zoo and Wildlife Research, Forschungsverbund Berlin e.V., Berlin, Germany
| | - Katrien Vanderperren
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Ghent University, Ghent, Belgium
| | - Robert Klopfleisch
- Institute for Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Racem Ben Romdhane
- Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany
| | | | - Anna Ehrle
- Equine Clinic, Surgery and Radiology, Freie Universität Berlin, Berlin, Germany
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Ji T, Feng Z, Sun E, Ng SK, Su L, Zhang Y, Han D, Han-Oh S, Iordachita I, Lee J, Kazanzides P, Bell MAL, Wong J, Ding K. A phantom-based analysis for tracking intra-fraction pancreatic tumor motion by ultrasound imaging during radiation therapy. Front Oncol 2022; 12:996537. [PMID: 36237341 PMCID: PMC9552199 DOI: 10.3389/fonc.2022.996537] [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: 07/17/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeIn this study, we aim to further evaluate the accuracy of ultrasound tracking for intra-fraction pancreatic tumor motion during radiotherapy by a phantom-based study.MethodsTwelve patients with pancreatic cancer who were treated with stereotactic body radiation therapy were enrolled in this study. The displacement points of the respiratory cycle were acquired from 4DCT and transferred to a motion platform to mimic realistic breathing movements in our phantom study. An ultrasound abdominal phantom was placed and fixed in the motion platform. The ground truth of phantom movement was recorded by tracking an optical tracker attached to this phantom. One tumor inside the phantom was the tracking target. In the evaluation of the results, the monitoring results from the ultrasound system were compared with the phantom motion results from the infrared camera. Differences between infrared monitoring motion and ultrasound tracking motion were analyzed by calculating the root-mean-square error.ResultsThe 82.2% ultrasound tracking motion was within a 0.5 mm difference value between ultrasound tracking displacement and infrared monitoring motion. 0.7% ultrasound tracking failed to track accurately (a difference value > 2.5 mm). These differences between ultrasound tracking motion and infrared monitored motion do not correlate with respiratory displacements, respiratory velocity, or respiratory acceleration by linear regression analysis.ConclusionsThe highly accurate monitoring results of this phantom study prove that the ultrasound tracking system may be a potential method for real-time monitoring targets, allowing more accurate delivery of radiation doses.
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Affiliation(s)
- Tianlong Ji
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Ziwei Feng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Edward Sun
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sook Kien Ng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Lin Su
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Yin Zhang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Dong Han
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sarah Han-Oh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Iulian Iordachita
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Junghoon Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Peter Kazanzides
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, United States
| | - Muyinatu A. Lediju Bell
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - John Wong
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kai Ding
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- *Correspondence: Kai Ding,
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Mørkeset ST, Lervåg C, Lund JÅ, Jensen C. Clinical experience of volumetric-modulated flattening filter free stereotactic body radiation therapy of lesions in the lung with deep inspiration breath-hold. J Appl Clin Med Phys 2022; 23:e13733. [PMID: 35867387 PMCID: PMC9512343 DOI: 10.1002/acm2.13733] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/19/2022] [Accepted: 06/23/2022] [Indexed: 11/05/2022] Open
Abstract
This clinical study aimed to evaluate lung cancer patients' ability to perform deep inspiration breath-hold (DIBH) during CT simulation and throughout the treatment course of stereotactic body radiation therapy (SBRT). In addition, target sizes, organ at risk (OAR) sizes, and doses to the respective volumes in filter-free volumetric-modulated arc therapy plans performed under free-breathing (FB) and DIBH conditions were evaluated. Twenty-one patients with peripheral lesions were included, of which 13 were eligible for SBRT. All patients underwent training for breath-hold during CT, and if they complied with the requirements, two CT scans were obtained: CT scan in DIBH and a four-dimensional CT scan in FB. The treatment plans in FB and DIBH were generated, and the dose parameters and volume sizes were compared. The endpoints for evaluation were patient compliance, target dose coverage, and doses to the OARs. This clinical study showed high patient DIBH compliance during both CT simulation and treatment for patients with lung cancer. A significant reduction in target volumes was achieved with SBRT in DIBH, in addition to significantly decreased doses to the heart, chest wall, and lungs. DIBH in SBRT of lung lesions is feasible, and a routine to manage intra-fractional deviation should be established upon implementation.
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Affiliation(s)
- Siri T Mørkeset
- Department of Oncology and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | - Christoffer Lervåg
- Department of Oncology and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | - Jo-Åsmund Lund
- Department of Oncology and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway.,Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
| | - Christer Jensen
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway.,Department of Medicine and Healthcare, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
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4
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Xiao H, Ni R, Zhi S, Li W, Liu C, Ren G, Teng X, Liu W, Wang W, Zhang Y, Wu H, Lee HFV, Cheung LYA, Chang HCC, Li T, Cai J. A Dual-supervised Deformation Estimation Model (DDEM) for constructing ultra-quality 4D-MRI based on a commercial low-quality 4D-MRI for liver cancer radiation therapy. Med Phys 2022; 49:3159-3170. [PMID: 35171511 DOI: 10.1002/mp.15542] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/09/2022] [Accepted: 02/09/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Most available 4D-MRI techniques are limited by insufficient image quality and long acquisition times or require specially designed sequences or hardware that are not available in the clinic. These limitations have greatly hindered the clinical implementation of 4D-MRI. PURPOSE This study aims to develop a fast ultra-quality (UQ) 4D-MRI reconstruction method using a commercially available 4D-MRI sequence and dual-supervised deformation estimation model (DDEM). METHODS Thirty-nine patients receiving radiotherapy for liver tumors were included. Each patient was scanned using a TWIST-VIBE MRI sequence to acquire 4D-MR images. They also received 3D T1-/T2-weighted MRI scans as prior images and UQ 4D-MRI at any instant was considered a deformation of them. A DDEM was developed to obtain a 4D deformable vector field (DVF) from 4D-MRI data, and the prior images were deformed using this 4D-DVF to generate UQ 4D-MR images. The registration accuracies of the DDEM, VoxelMorph (normalized cross-correlation (NCC) supervised), VoxelMorph (end-to-end point error (EPE) supervised), and the parametric total variation (pTV) algorithm were compared. Tumor motion on UQ 4D-MRI was evaluated quantitatively using region-of-interest (ROI) tracking errors, while image quality was evaluated using the contrast-to-noise ratio (CNR), lung-liver edge sharpness, and perceptual blur metric (PBM). RESULTS The registration accuracy of the DDEM was significantly better than those of VoxelMorph (NCC supervised), VoxelMorph (EPE supervised) and the pTV algorithm (all, p < 0.001), with an inference time of 69.3 ± 5.9 ms. UQ 4D-MRI yielded ROI tracking errors of 0.79 ± 0.65, 0.50 ± 0.55, and 0.51 ± 0.58 mm in the superior-inferior, anterior-posterior, and mid-lateral directions, respectively. From the original 4D-MRI to UQ 4D-MRI, the CNR increased from 7.25 ± 4.89 to 18.86 ± 15.81; the lung-liver edge full-width-at-half-maximum decreased from 8.22 ± 3.17 to 3.65 ± 1.66 mm in the in-plane direction and from 8.79 ± 2.78 to 5.04 ± 1.67 mm in the cross-plane direction, and the PBM decreased from 0.68 ± 0.07 to 0.38 ± 0.01. CONCLUSION This novel DDEM method successfully generated UQ 4D-MR images based on a commercial 4D-MRI sequence. It shows great promise for improving liver tumor motion management during radiation therapy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Haonan Xiao
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Ruiyan Ni
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Shaohua Zhi
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Wen Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Chenyang Liu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Ge Ren
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Xinzhi Teng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Weiwei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing, 100000, China
| | - Weihu Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing, 100000, China
| | - Yibao Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing, 100000, China
| | - Hao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing, 100000, China
| | - Ho-Fun Victor Lee
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong SAR, 999077, China
| | - Lai-Yin Andy Cheung
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, 999077, China
| | | | - Tian Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
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5
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Zhou H, Li Y, Li J, Wu T, Chen Y, Shen Z. Radiation dosimetric influence by different target volume definition in Cyberknife lung cancer and abdomen stereotactic body radiotherapy. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2021. [DOI: 10.1080/16878507.2021.1967045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Han Zhou
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
- Department of Radiation Oncology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yikun Li
- Department of Radiation Oncology, Jinling Hospital, Nanjing University, Nanjing, China
| | - Jing Li
- Department of Radiation Oncology, Jinling Hospital, Nanjing University, Nanjing, China
| | - Tiancong Wu
- Department of Radiation Oncology, Jinling Hospital, Nanjing University, Nanjing, China
| | - Ying Chen
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Zetian Shen
- Department of Radiation Oncology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Stieb S, McDonald B, Gronberg M, Engeseth GM, He R, Fuller CD. Imaging for Target Delineation and Treatment Planning in Radiation Oncology: Current and Emerging Techniques. Hematol Oncol Clin North Am 2019; 33:963-975. [PMID: 31668214 DOI: 10.1016/j.hoc.2019.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Imaging in radiation oncology has a wide range of applications. It is necessary not only for tumor staging and treatment response assessment after therapy but also for the treatment planning process, including definition of target and organs at risk, as well as treatment plan calculation. This article provides a comprehensive overview of the main imaging modalities currently used for target delineation and treatment planning and gives insight into new and promising techniques.
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Affiliation(s)
- Sonja Stieb
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Brigid McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Mary Gronberg
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Grete May Engeseth
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Clifton David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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7
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Peng J, Gong J, Wang X, Mou J, Xu H, Dai J, Zhou F, Zhou Y. 4-Dimensional computed tomography analysis of clinical target volume displacement in adjuvant radiation of patients with gastric cancer and its implication on radiotherapy. Oncol Lett 2019; 17:3641-3648. [PMID: 30881488 PMCID: PMC6403517 DOI: 10.3892/ol.2019.10037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 11/13/2018] [Indexed: 12/24/2022] Open
Abstract
The present study aimed to accurately measure the displacement magnitude of the radiotherapy subsite target due to respiration, and to evaluate its implication on 4-dimensional computed tomography (4D-CT) in adjuvant radiation of gastric cancer. To investigate this, 10 patients with gastric cancer receiving adjuvant radiotherapy were enrolled. 4D-CT scans were performed on all patients and respiratory signals were recorded simultaneously. The clinical target volume (CTV) and 7 regions of interest (ROIs) were delineated in all phases of the CT imaging. The displacements of all ROIs in the cephalic-caudal, anterior-posterior and left-right directions were measured and analyzed. Two sets of plans based on planning target volume 3D (PTV3D) and PTV4D, were generated for each patient and PTV3Dcal was calculated by expanding the non-uniform margin on CTV3D according to the displacement analysis data. The dosimetric parameters and target volumes of the 3 radiotherapy treatment plans were compared. The displacement of the various ROIs varied widely. The mean PTV4D was smaller than the PTV3D and PTV3Dcal. Compared with Plan3D, Plan4D reduced the mean dose of radiation to the liver and left kidney by 23.2 and 43.5%, respectively. The liver volume receiving ≥30 Gy and the left kidney volume receiving ≥20 Gy were decreased by 10.8 and 29.7%, respectively. No differences were observed in the PTV coverage and protection of organs at risk (OARs) between Plan3Dcal and Plan4D. In conclusion, the breathing-induced displacement patterns of the subsite targets in patients with gastric cancer vary. The individualized CTV margins of expansion based on 4D-CT lead to a decrease PTV and radiation dose to OARs. The non-uniform margins in various directions should be considered as areas for further investigation.
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Affiliation(s)
- Jin Peng
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.,Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China.,Key Laboratory of Tumor Biology Behavior of Hubei Province, Wuhan, Hubei 430071, P.R. China
| | - Jun Gong
- Department of Radiation and Medical Oncology, Central Hospital of Huangshi City, Huangshi, Hubei 430000, P.R. China
| | - Xiaoyong Wang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.,Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China.,Key Laboratory of Tumor Biology Behavior of Hubei Province, Wuhan, Hubei 430071, P.R. China
| | - Jingjing Mou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.,Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China.,Key Laboratory of Tumor Biology Behavior of Hubei Province, Wuhan, Hubei 430071, P.R. China
| | - Hui Xu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.,Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China.,Key Laboratory of Tumor Biology Behavior of Hubei Province, Wuhan, Hubei 430071, P.R. China
| | - Jing Dai
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.,Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China.,Key Laboratory of Tumor Biology Behavior of Hubei Province, Wuhan, Hubei 430071, P.R. China
| | - Fuxiang Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.,Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China.,Key Laboratory of Tumor Biology Behavior of Hubei Province, Wuhan, Hubei 430071, P.R. China
| | - Yunfeng Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.,Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China.,Key Laboratory of Tumor Biology Behavior of Hubei Province, Wuhan, Hubei 430071, P.R. China
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Caillet V, O'Brien R, Moore D, Poulsen P, Pommer T, Colvill E, Sawant A, Booth J, Keall P. Technical Note: In silico and experimental evaluation of two leaf-fitting algorithms for MLC tracking based on exposure error and plan complexity. Med Phys 2019; 46:1814-1820. [PMID: 30719723 DOI: 10.1002/mp.13425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Multileaf collimator (MLC) tracking is being clinically pioneered to continuously compensate for thoracic and pelvic motion during radiotherapy. The purpose of this work was to characterize the performance of two MLC leaf-fitting algorithms, direct optimization and piecewise optimization, for real-time motion compensation with different plan complexity and tumor trajectories. METHODS To test the algorithms, both in silico and phantom experiments were performed. The phantom experiments were performed on a Trilogy Varian linac and a HexaMotion programmable motion platform. High and low modulation VMAT plans for lung and prostate cancer cases were used along with eight patient-measured organ-specific trajectories. For both MLC leaf-fitting algorithms, the plans were run with their corresponding patient trajectories. To compare algorithms, the average exposure errors, i.e., the difference in shape between ideal and fitted MLC leaves by the algorithm, plan complexity and system latency of each experiment were calculated. RESULTS Comparison of exposure errors for the in silico and phantom experiments showed minor differences between the two algorithms. The average exposure errors for in silico experiments with low/high plan complexity were 0.66/0.88 cm2 for direct optimization and 0.66/0.88 cm2 for piecewise optimization, respectively. The average exposure errors for the phantom experiments with low/high plan complexity were 0.73/1.02 cm2 for direct and 0.73/1.02 cm2 for piecewise optimization, respectively. The measured latency for the direct optimization was 226 ± 10 ms and for the piecewise algorithm was 228 ± 10 ms. In silico and phantom exposure errors quantified for each treatment plan demonstrated that the exposure errors from the high plan complexity (0.96 cm2 mean, 2.88 cm2 95% percentile) were all significantly different from the low plan complexity (0.70 cm2 mean, 2.18 cm2 95% percentile) (P < 0.001, two-tailed, Mann-Whitney statistical test). CONCLUSIONS The comparison between the two leaf-fitting algorithms demonstrated no significant differences in exposure errors, neither in silico nor with phantom experiments. This study revealed that plan complexity impacts the overall exposure errors significantly more than the difference between the algorithms.
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Affiliation(s)
- Vincent Caillet
- Northern Sydney Cancer Centre, Sydney, NSW, Australia.,ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Ricky O'Brien
- ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Douglas Moore
- Beyond Center for Fundamental Concepts in Science, Arizona State University, Tempe, AZ, USA
| | | | - Tobias Pommer
- Unit of Radiotherapy Physics and Engineering, Karolinska University Hospital, Solna, Sweden
| | - Emma Colvill
- Northern Sydney Cancer Centre, Sydney, NSW, Australia.,ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Amit Sawant
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jeremy Booth
- Northern Sydney Cancer Centre, Sydney, NSW, Australia.,ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Paul Keall
- ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Alagar AGB, Ganesh KM, Kaviarasu K. Dose Calculation Accuracy of AAA and AcurosXB Algorithms for Small Central and Interface Lung Lesions - Verification with Gafchromic Film Dosimetry. Asian Pac J Cancer Prev 2018; 19:253-259. [PMID: 29374410 PMCID: PMC5844627 DOI: 10.22034/apjcp.2018.19.1.253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Dose calculation for small field radiotherapy with heterogeneity often involves discrepancies, so that algorithms used by treatment planning systems (TPS) should be evaluated with reference to achieving optimal treatment results. Accuracy of two model based algorithms, AcurosXB (AcXB) and the analytical anisotropic algorithm (AAA) from Eclipse TPS, were here tested. Measurements are made using Gafchromic EBT3 films with indigenously generated lung phantoms irradiated with 6 MV photons. Lung phantoms contained two types of tumor plugs, one kept at an interface attached to the chest wall in right lung (RIT) and the other at the centre of the left lung (LCT). RIT and LCT were studied with two different tumor diameters, 1.5 cm and 2.5 cm. Scanned images were planned in TPS with 3D-CRT, IMRT and VMAT and individual plans for each tumor were irradiated keeping the Gafchromic film at the centre of the tumor to evaluate the dose distribution in the central plane. Both algorithms, irrespective of delivery techniques, showed more deviation with smaller than larger diameter tumors. Also, both demonstrated maximum deviation at the junction of tumor and lung in both RIT and LCT cases. However, the deviation observed was higher with AAA and a minimal acceptable deviation of within 4 % was achieved with AcurosXB.
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Affiliation(s)
- Ananda Giri Babu Alagar
- Research and Development Centre, Bharathiar University, Coimbatore, India.,Department of Radiation Oncology, Krishna Institute of Medical Sciences, Secunderabad, India.
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Peng J, Zhang Z, Wang J, Xie J, Hu W. Is internal target volume accurate for dose evaluation in lung cancer stereotactic body radiotherapy? Oncotarget 2017; 7:22523-30. [PMID: 26968812 PMCID: PMC5008378 DOI: 10.18632/oncotarget.8000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 02/24/2016] [Indexed: 12/31/2022] Open
Abstract
Purpose 4DCT delineated internal target volume (ITV) was applied to determine the tumor motion and used as planning target in treatment planning in lung cancer stereotactic body radiotherapy (SBRT). This work is to study the accuracy of using ITV to predict the real target dose in lung cancer SBRT. Materials and methods Both for phantom and patient cases, the ITV and gross tumor volumes (GTVs) were contoured on the maximum intensity projection (MIP) CT and ten CT phases, respectively. A SBRT plan was designed using ITV as the planning target on average projection (AVG) CT. This plan was copied to each CT phase and the dose distribution was recalculated. The GTV_4D dose was acquired through accumulating the GTV doses over all ten phases and regarded as the real target dose. To analyze the ITV dose error, the ITV dose was compared to the real target dose by endpoints of D99, D95, D1 (doses received by the 99%, 95% and 1% of the target volume), and dose coverage endpoint of V100(relative volume receiving at least the prescription dose). Results The phantom study shows that the ITV underestimates the real target dose by 9.47%∼19.8% in D99, 4.43%∼15.99% in D95, and underestimates the dose coverage by 5% in V100. The patient cases show that the ITV underestimates the real target dose and dose coverage by 3.8%∼10.7% in D99, 4.7%∼7.2% in D95, and 3.96%∼6.59% in V100 in motion target cases. Conclusions Cautions should be taken that ITV is not accurate enough to predict the real target dose in lung cancer SBRT with large tumor motions. Restricting the target motion or reducing the target dose heterogeneity could reduce the ITV dose underestimation effect in lung SBRT.
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Affiliation(s)
- Jiayuan Peng
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiang Xie
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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11
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Chairmadurai A, Goel HC, Jain SK, Kumar P. Radiobiological analysis of stereotactic body radiation therapy for an evidence-based planning target volume of the lung using multiphase CT images obtained with a pneumatic abdominal compression apparatus: a case study. Radiol Phys Technol 2017; 10:525-534. [PMID: 29128934 DOI: 10.1007/s12194-017-0431-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 11/30/2022]
Abstract
This study evaluated the efficiency of stereotactic body radiation therapy of lung (SBRT-Lung) in generating a treatment volume using conventional multiple-phase three-dimensional computed tomography (3D-CT) of a patient immobilized with pneumatic abdominal compression. The institutional protocol for SBRT-Lung using the RapidArc technique relied on a planning target volume (PTV) delineated using 3D-CT and accounted for linear and angular displacement of the tumor during respiratory movements. The efficiency of the institutional protocol was compared with that of a conventional method for PTV delineation based on radiobiological estimates, such as tumor control probability (TCP) and normal tissue complication probability (NTCP), evaluated using dose-volume parameters. Pneumatic abdominal compression improved the TCP by 15%. This novel protocol improved the TCP by 0.5% but reduced the NTCP for lung pneumonitis (0.2%) and rib fracture (1.0%). Beyond the observed variations in the patient's treatment setup, the institutional protocol yielded a significantly consistent TCP (p < 0.005). The successful clinical outcome of this case study corroborates predictions based on radiobiological evaluation and deserves validation through an increased number of patients.
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Affiliation(s)
- Arun Chairmadurai
- Department of Radiation Oncology, Jaypee Hospital, Sector-128, Noida, UP, 201304, India.
| | - Harish Chandra Goel
- Amity Centre for Radiation Biology, Amity University, Noida, UP, 201304, India
| | - Sandeep Kumar Jain
- Department of Radiation Oncology, Jaypee Hospital, Sector-128, Noida, UP, 201304, India
| | - Pawan Kumar
- Department of Radiation Oncology, Jaypee Hospital, Sector-128, Noida, UP, 201304, India
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12
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Yoganathan SA, Maria Das KJ, Agarwal A, Kumar S. Magnitude, Impact, and Management of Respiration-induced Target Motion in Radiotherapy Treatment: A Comprehensive Review. J Med Phys 2017; 42:101-115. [PMID: 28974854 PMCID: PMC5618455 DOI: 10.4103/jmp.jmp_22_17] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/31/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022] Open
Abstract
Tumors in thoracic and upper abdomen regions such as lungs, liver, pancreas, esophagus, and breast move due to respiration. Respiration-induced motion introduces uncertainties in radiotherapy treatments of these sites and is regarded as a significant bottleneck in achieving highly conformal dose distributions. Recent developments in radiation therapy have resulted in (i) motion-encompassing, (ii) respiratory gating, and (iii) tracking methods for adapting the radiation beam aperture to account for the respiration-induced target motion. The purpose of this review is to discuss the magnitude, impact, and management of respiration-induced tumor motion.
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Affiliation(s)
- S. A. Yoganathan
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - K. J. Maria Das
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arpita Agarwal
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shaleen Kumar
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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13
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Wild AT, Yamada Y. Treatment Options in Oligometastatic Disease: Stereotactic Body Radiation Therapy - Focus on Colorectal Cancer. Visc Med 2017; 33:54-61. [PMID: 28612018 DOI: 10.1159/000454685] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Improvements in systemic therapy for metastatic colorectal cancer (CRC) have markedly extended survival, rendering local control of metastases to critical organs of increasing importance, especially in the oligometastatic setting where the disease may not yet have acquired the ability to widely disseminate. While surgical resection remains the gold standard for oligometastases in many organs, stereotactic body radiation therapy (SBRT) presents a non-invasive alternative for achieving local control. METHODS A literature review was performed to identify and summarize the findings of key prospective and retrospective studies that have shaped the field of SBRT for oligometastases to the lung, liver, and spine with a focus on oligometastases from CRC in particular. RESULTS Modern dose-escalated SBRT regimens can achieve 1-year local control rates of 77-100%, 90-100%, and 81-95% for oligometastases involving the lung, liver, and spine, respectively. Rates of grade 3 or greater toxicity with contemporary SBRT techniques are consistently low at <10% in the lung, <5% in the liver, and <2%/8% for neurologic/non-neurologic toxicity in the spine, respectively. CONCLUSION SBRT appears safe and effective for treating oligometastases involving the lung, liver, and spine. Randomized trials comparing SBRT to surgical resection and other local therapeutic modalities for the treatment of CRC oligometastases bear consideration.
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Affiliation(s)
- Aaron T Wild
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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14
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Khamfongkhruea C, Thongsawad S, Tannanonta C, Chamchod S. Comparison of CT images with average intensity projection, free breathing, and mid-ventilation for dose calculation in lung cancer. J Appl Clin Med Phys 2017; 18:26-36. [PMID: 28300381 PMCID: PMC5689962 DOI: 10.1002/acm2.12037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 12/06/2016] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to compare three computed tomography (CT) images under different conditions-average intensity projection (AIP), free breathing (FB), mid-ventilation (MidV)-used for radiotherapy contouring and planning in lung cancer patients. Two image sets derived from four-dimensional CT (4DCT) acquisition (AIP and MidV) and three-dimensional CT with FB were generated and used to plan for 29 lung cancer patients. Organs at risk (OARs) were delineated for each image. AIP images were calculated with 3D conformal radiotherapy (3DCRT) and intensity-modulated radiation therapy (IMRT). Planning with the same target coverage was applied to the FB and MidV image sets. Plans with small and large tumors were compared regarding OAR volumes, geometrical center differences in OARs, and dosimetric indices. A gamma index analysis was also performed to compare dose distributions. There were no significant differences (P > 0.05) in OAR volumes, the geometrical center differences, maximum and mean doses of the OARs between both tumor sizes. For 3DCRT, the gamma analysis results indicated an acceptable dose distribution agreement of 95% with 2%/2 mm criteria. Although, the gamma index results show distinct contrast of dose distribution outside the planning target volume (PTV) in IMRT, but within the PTV, it was acceptable. All three images could be used for OAR delineation and dose calculation in lung cancer. AIP image sets seemed to be suitable for dose calculation while patient movement between series acquisition of FB images should be considered when defining target volumes on 4DCT images.
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Affiliation(s)
- Chirasak Khamfongkhruea
- Radiation Oncology Department, Chulabhorn Hospital, Chulabhorn Royal Academy of Science, Bangkok, Thailand
| | - Sangutid Thongsawad
- Radiation Oncology Department, Chulabhorn Hospital, Chulabhorn Royal Academy of Science, Bangkok, Thailand
| | - Chirapha Tannanonta
- Radiation Oncology Department, Chulabhorn Hospital, Chulabhorn Royal Academy of Science, Bangkok, Thailand
| | - Sasikarn Chamchod
- Radiation Oncology Department, Chulabhorn Hospital, Chulabhorn Royal Academy of Science, Bangkok, Thailand
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15
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Rouabhi O, Ma M, Bayouth J, Xia J. Impact of temporal probability in 4D dose calculation for lung tumors. J Appl Clin Med Phys 2015; 16:110-118. [PMID: 26699562 PMCID: PMC5691019 DOI: 10.1120/jacmp.v16i6.5517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 07/05/2015] [Accepted: 07/01/2015] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to evaluate the dosimetric uncertainty in 4D dose calculation using three temporal probability distributions: uniform distribution, sinusoidal distribution, and patient‐specific distribution derived from the patient respiratory trace. Temporal probability, defined as the fraction of time a patient spends in each respiratory amplitude, was evaluated in nine lung cancer patients. Four‐dimensional computed tomography (4D CT), along with deformable image registration, was used to compute 4D dose incorporating the patient's respiratory motion. First, the dose of each of 10 phase CTs was computed using the same planning parameters as those used in 3D treatment planning based on the breath‐hold CT. Next, deformable image registration was used to deform the dose of each phase CT to the breath‐hold CT using the deformation map between the phase CT and the breath‐hold CT. Finally, the 4D dose was computed by summing the deformed phase doses using their corresponding temporal probabilities. In this study, 4D dose calculated from the patient‐specific temporal probability distribution was used as the ground truth. The dosimetric evaluation matrix included: 1) 3D gamma analysis, 2) mean tumor dose (MTD), 3) mean lung dose (MLD), and 4) lung V20. For seven out of nine patients, both uniform and sinusoidal temporal probability dose distributions were found to have an average gamma passing rate >95% for both the lung and PTV regions. Compared with 4D dose calculated using the patient respiratory trace, doses using uniform and sinusoidal distribution showed a percentage difference on average of −0.1%±0.6% and −0.2%±0.4% in MTD, −0.2%±1.9% and −0.2%±1.3% in MLD, 0.09%±2.8% and −0.07%±1.8% in lung V20, −0.1%±2.0% and 0.08%±1.34% in lung V10, 0.47%±1.8% and 0.19%±1.3% in lung V5, respectively. We concluded that four‐dimensional dose computed using either a uniform or sinusoidal temporal probability distribution can approximate four‐dimensional dose computed using the patient‐specific respiratory trace. PACS number: 87.55.D‐
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16
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Kwong Y, Mel AO, Wheeler G, Troupis JM. Four-dimensional computed tomography (4DCT): A review of the current status and applications. J Med Imaging Radiat Oncol 2015; 59:545-54. [DOI: 10.1111/1754-9485.12326] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 04/19/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Yune Kwong
- Department of Diagnostic Imaging; Monash Health; Melbourne Victoria Australia
| | - Alexandra Olimpia Mel
- Department of Biomedical Radiation Science; Faculty of Medicine; Dentistry and Nursing; Monash University; Melbourne Victoria Australia
| | - Greg Wheeler
- Department of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - John M Troupis
- Department of Diagnostic Imaging; Monash Health; Melbourne Victoria Australia
- Department of Biomedical Radiation Science; Faculty of Medicine; Dentistry and Nursing; Monash University; Melbourne Victoria Australia
- Monash Cardiovascular Research Centre; Monash University; Melbourne Victoria Australia
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17
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Shang DP, Liu CX, Yin Y. A comparison of the different 3D CT scanning modes on the GTV delineation for the solitary pulmonary lesion. Radiat Oncol 2014; 9:211. [PMID: 25391554 PMCID: PMC4289396 DOI: 10.1186/1748-717x-9-211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 08/28/2014] [Indexed: 12/01/2022] Open
Abstract
Objectives To investigate the impacts of the different three-dimensional CT (3DCT) scanning modes on the GTV delineation for solitary pulmonary lesion (SPL) based on four-dimensional CT (4DCT), and to evaluate the feasibility of using the spiral CT scan in CT simulation. Materials and methods Twenty-one patients with SPL underwent axial CT scan, spiral CT scan and 4DCT simulation scan during free-breathing, respectively. The same clinical radiation oncologist delineated the gross tumor volume (GTV) under the same CT window setting. GTVA and GTVS were created from the axial and spiral images, respectively. ITVMIP was created from the maximum intensity projection (MIP) reconstructed 4D images. The target volumes and position between GTVA, GTVS and ITVMIP were compared. The matching index (MI) between GTVA and GTVS, and the correlation between MI and GTVS were evaluated. Results ITVMIP was significantly larger than GTVA and GTVS (ps = 0.000). The ratios of ITVMIP to GTVA and GTVS were 1.57 ± 0.54 and 1.66 ± 0.61, respectively. There was no significant difference between GTVA and GTVS(p = 0.16). A comparison of the centroidal positions in x, y, and z directions for GTVA, GTVS and GTV4Dmip showed no significant difference (px = 0.17, py = 0.40, pz = 0.48). Additionally, there was no difference between distances from the centroidal positions of GTVA and GTVS to the origin of coordinates (p = 0.51). MI between GTVA and GTVS was 0.41 ± 0.24 (range 0–0.89), and it was positively correlated with the tumor volume (r = 0.64, p = 0.002). Conclusion There was no impact on the volume or centroidal position of GTV by the axial scan or spiral scan in 3DCT simulation for SPL. MI between GTVA and GTVS was small. A positively correlation was found between MI and GTVS. Relative to axial scanning mode, spiral CT scan was more timesaving and more efficient, it was feasible in 3DCT simulation for SPL.
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Affiliation(s)
| | | | - Yong Yin
- Department of Radiation Oncology, Shandong Tumor Hospital, Shandong Province 250117, China.
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18
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Nishibuchi I, Kimura T, Nakashima T, Ochi Y, Takahashi I, Doi Y, Kenjo M, Kaneyasu Y, Ozawa S, Murakami Y, Wadasaki K, Nagata Y. Time-adjusted internal target volume: a novel approach focusing on heterogeneity of tumor motion based on 4-dimensional computed tomography imaging for radiation therapy planning of lung cancer. Int J Radiat Oncol Biol Phys 2014; 89:1129-1137. [PMID: 25035218 DOI: 10.1016/j.ijrobp.2014.04.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 04/04/2014] [Accepted: 04/25/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To consider nonuniform tumor motion within the internal target volume (ITV) by defining time-adjusted ITV (TTV), a volume designed to include heterogeneity of tumor existence on the basis of 4-dimensional computed tomography (4D-CT). METHODS AND MATERIALS We evaluated 30 lung cancer patients. Breath-hold CT (BH-CT) and free-breathing 4D-CT scans were acquired for each patient. The tumors were manually delineated using a lung CT window setting (window, 1600 HU; level, -300 HU). Tumor in BH-CT images was defined as gross tumor volume (GTV), and the sum of tumors in 4D-CT images was defined as ITV-4D. The TTV images were generated from the 4D-CT datasets, and the tumor existence probability within ITV-4D was calculated. We calculated the TTV80 value, which is the percentage of the volume with a tumor existence probability that exceeded 80% on ITV-4D. Several factors that affected the TTV80 value, such as the ITV-4D/GTV ratio or tumor centroid deviation, were evaluated. RESULTS Time-adjusted ITV images were acquired for all patients, and tumor respiratory motion heterogeneity was visualized. The median (range) ITV-4D/GTV ratio and median tumor centroid deviation were 1.6 (1.0-4.1) and 6.3 mm (0.1-30.3 mm), respectively. The median TTV80 value was 43.3% (2.9-98.7%). Strong correlations were observed between the TTV80 value and the ITV-4D/GTV ratio (R=-0.71) and tumor centroid deviation (R=-0.72). The TTV images revealed the tumor motion pattern features within ITV. CONCLUSIONS The TTV images reflected nonuniform tumor motion, and they revealed the tumor motion pattern features, suggesting that the TTV concept may facilitate various aspects of radiation therapy planning of lung cancer while incorporating respiratory motion in the future.
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Affiliation(s)
- Ikuno Nishibuchi
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan; Department of Radiation Oncology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Tomoki Kimura
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
| | - Takeo Nakashima
- Division of Radiation Therapy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yusuke Ochi
- Division of Radiation Therapy, Hiroshima University Hospital, Hiroshima, Japan
| | - Ippei Takahashi
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Doi
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Kenjo
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuko Kaneyasu
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Syuichi Ozawa
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Koichi Wadasaki
- Department of Radiation Oncology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Chi A, Nguyen NP, Komaki R. The potential role of respiratory motion management and image guidance in the reduction of severe toxicities following stereotactic ablative radiation therapy for patients with centrally located early stage non-small cell lung cancer or lung metastases. Front Oncol 2014; 4:151. [PMID: 25009800 PMCID: PMC4070060 DOI: 10.3389/fonc.2014.00151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 05/30/2014] [Indexed: 12/25/2022] Open
Abstract
Image guidance allows delivery of very high doses of radiation over a few fractions, known as stereotactic ablative radiotherapy (SABR). This treatment is associated with excellent outcome for early stage non-small cell lung cancer and metastases to the lungs. In the delivery of SABR, central location constantly poses a challenge due to the difficulty of adequately sparing critical thoracic structures that are immediately adjacent to the tumor if an ablative dose of radiation is to be delivered to the tumor target. As of current, various respiratory motion management and image guidance strategies can be used to ensure accurate tumor target localization prior and/or during daily treatment, which allows for maximal and safe reduction of set up margins. The incorporation of both may lead to the most optimal normal tissue sparing and the most accurate SABR delivery. Here, the clinical outcome, treatment related toxicities, and the pertinent respiratory motion management/image guidance strategies reported in the current literature on SABR for central lung tumors are reviewed.
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Affiliation(s)
- Alexander Chi
- Department of Radiation Oncology, Mary Babb Randolph Cancer Center of West Virginia University , Morgantown, WV , USA
| | | | - Ritsuko Komaki
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston, TX , USA
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20
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Tatekawa K, Iwata H, Kawaguchi T, Ishikura S, Baba F, Otsuka S, Miyakawa A, Iwana M, Shibamoto Y. Changes in volume of stage I non-small-cell lung cancer during stereotactic body radiotherapy. Radiat Oncol 2014; 9:8. [PMID: 24393430 PMCID: PMC3904205 DOI: 10.1186/1748-717x-9-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 01/03/2014] [Indexed: 11/17/2022] Open
Abstract
Background The overall treatment time of stereotactic body radiotherapy (SBRT) for non-small-cell lung cancer is usually 3 to over 10 days. If it is longer than 7 days, tumor volume expansion during SBRT may jeopardize the target dose coverage. In this study, volume change of stage I NSCLC during SBRT was investigated. Methods Fifty patients undergoing 4-fraction SBRT with a total dose of 48 Gy (n = 36) or 52 Gy (n = 14) were analyzed. CT was taken for registration at the first and third SBRT sessions with an interval of 7 days in all patients. Patient age was 29–87 years (median, 77), and 39 were men. Histology was adenocarcinoma in 28, squamous cell carcinoma in 17, and others in 5. According to the UICC 7th classification, T-stage was T1a in 9 patients, T1b in 27, and T2a in 14. Tumor volumes on the first and 8th days were determined on CT images taken during the exhalation phase, by importing the data into the Dr. View/LINAX image analysis system. After determining the optimal threshold for distinguishing tumor from pulmonary parenchyma, the region above -250 HU was automatically extracted and the tumor volumes were calculated. Results The median tumor volume was 7.3 ml (range, 0.5-35.7) on day 1 and 7.5 ml (range, 0.5-35.7) on day 8. Volume increase of over 10% was observed in 16 cases (32%); increases by >10 to ≤20%, >20 to ≤30%, and >30% were observed in 9, 5, and 2 cases, respectively. The increase in the estimated tumor diameter was over 2 mm in 3 cases and 1–2 mm in 6. A decrease of 10% or more was seen in 3 cases. Among the 16 tumors showing a volume increase of over 10%, T-stage was T1a in 2 patients, T1b in 9, and T2a in 5. Histology was adenocarcinoma in 10 patients, squamous cell carcinoma in 5, and others in 1. Conclusions Volume expansion >10% was observed in 32% of the tumors during the first week of SBRT, possibly due to edema or sustained tumor progression. When planning SBRT, this phenomenon should be taken into account.
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Affiliation(s)
- Kotoha Tatekawa
- Department of Radiology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
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Wu J, Betzing C, He TT, Fuss M, D'Souza WD. Dosimetric comparison of patient setup strategies in stereotactic body radiation therapy for lung cancer. Med Phys 2013; 40:051709. [PMID: 23635257 DOI: 10.1118/1.4801926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In this work, the authors retrospectively compared the accumulated dose over the treatment course for stereotactic body radiation therapy (SBRT) of lung cancer for three patient setup strategies. METHODS Ten patients who underwent lung SBRT were selected for this study. At each fraction, patients were immobilized using a vacuum cushion and were CT scanned. Treatment plans were performed on the simulation CT. The planning target volume (PTV) was created by adding a 5-mm uniform margin to the internal target volume derived from the 4DCT. All plans were normalized such that 99% of the PTV received 60 Gy. The plan parameters were copied onto the daily CT images for dose recalculation under three setup scenarios: skin marker, bony structure, and soft tissue based alignments. The accumulated dose was calculated by summing the dose at each fraction along the trajectory of a voxel over the treatment course through deformable image registration of each CT with the planning CT. The accumulated doses were analyzed for the comparison of setup accuracy. RESULTS The tumor volume receiving 60 Gy was 91.7 ± 17.9%, 74.1 ± 39.1%, and 99.6 ± 1.3% for setup using skin marks, bony structures, and soft tissue, respectively. The isodose line covering 100% of the GTV was 55.5 ± 7.1, 42.1 ± 16.0, and 64.3 ± 7.1 Gy, respectively. The corresponding average biologically effective dose of the tumor was 237.3 ± 29.4, 207.4 ± 61.2, and 258.3 ± 17.7 Gy, respectively. The differences in lung biologically effective dose, mean dose, and V20 between the setup scenarios were insignificant. CONCLUSIONS The authors' results suggest that skin marks and bony structure are insufficient for aligning patients in lung SBRT. Soft tissue based alignment is needed to match the prescribed dose delivered to the tumors.
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Affiliation(s)
- Jianzhou Wu
- Radiation Oncology, Swedish Cancer Institute, Seattle, Washington 98104, USA.
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Li F, Li J, Zhang Y, Xu M, Shang D, Fan T, Liu T, Shao Q. Geometrical differences in gross target volumes between 3DCT and 4DCT imaging in radiotherapy for non-small-cell lung cancer. JOURNAL OF RADIATION RESEARCH 2013; 54:950-6. [PMID: 23564841 PMCID: PMC3766289 DOI: 10.1093/jrr/rrt017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 02/06/2013] [Accepted: 02/08/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to explore the characteristic of 3DCT scanning phases and estimate the comparative amount of respiration motion information included in 3DCT and 4DCT by comparing the volumetric and positional difference between the volumes from 3DCT and 4DCT for the radiotherapy of non-small-cell lung cancer (NSCLC). A total of 28 patients with NSCLC sequentially underwent 3DCT and 4DCT simulation scans of the thorax during free breathing. The 4DCT images with respiratory signal data were reconstructed and sorted into 10 phases throughout a respiratory cycle. GTV-3D from 3DCT, GTV-0%, GTV-20%, GTV-50% and GTV-70% from end-inspiration, mid-expiration, end-expiration and mid-inspiration of 4DCT, and the internal GTV (IGTV-10) from the fused phase of 4DCT were delineated based on the 50% phase image, respectively. The differences in the position, size, matching index (MI) and degree of inclusion (DI) for different volumes were evaluated. The variation in the centroid shifts of GTV-0% and GTV-3D, GTV-20% and GTV-3D, GTV-50% and GTV-3D, and GTV-90% and GTV-3D in the 3D direction was not significant (P = 0.990). The size ratios of GTV-0%, GTV-20%, GTV-50%, GTV-70% and IGTV-10 to GTV-3D were 0.94 ± 0.18, 0.95 ± 0.18, 0.98 ± 0.15, 1.00 ± 0.18 and 1.60 ± 0.55, respectively. DIs of GTV-3D in IGTV-10, and IGTV-10 in GTV-3D were 0.88 ± 0.14 and 0.59 ± 0.16 (P < 0.001). The 3DCT scanning phases are irregular. The CTV-to-ITV expansion should be isotropic when defining the ITV on the 3DCT. The internal GTV derived from 4DCT cannot completely include the GTV from 3DCT. An additional margin may be required when defining the ITV-based 4DCT.
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Affiliation(s)
- Fengxing Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan 250117, China
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan 250117, China
| | - Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan 250117, China
| | - Min Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan 250117, China
| | - Dongping Shang
- Big Bore CT Room, Shandong Cancer Hospital and Institute, Jinan 250117, China
| | - Tingyong Fan
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan 250117, China
| | - Tonghai Liu
- Big Bore CT Room, Shandong Cancer Hospital and Institute, Jinan 250117, China
| | - Qian Shao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan 250117, China
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Wang H, Gong G, Wang H, Li D, Yin Y, Lu J. Performance evaluations of demons and free form deformation algorithms for the liver region. Technol Cancer Res Treat 2013; 13:101-8. [PMID: 23919395 DOI: 10.7785/tcrt.2012.500369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We investigated the influence of breathing motion on radiation therapy according to four- dimensional computed tomography (4D-CT) technology and indicated the registration of 4D-CT images was significant. The demons algorithm in two interpolation modes was compared to the FFD model algorithm to register the different phase images of 4D-CT in tumor tracking, using iodipin as verification. Linear interpolation was used in both mode 1 and mode 2. Mode 1 set outside pixels to nearest pixel, while mode 2 set outside pixels to zero. We used normalized mutual information (NMI), sum of squared differences, modified Hausdorff-distance, and registration speed to evaluate the performance of each algorithm. The average NMI after demons registration method in mode 1 improved 1.76% and 4.75% when compared to mode 2 and FFD model algorithm, respectively. Further, the modified Hausdorff-distance was no different between demons modes 1 and 2, but mode 1 was 15.2% lower than FFD. Finally, demons algorithm has the absolute advantage in registration speed. The demons algorithm in mode 1 was therefore found to be much more suitable for the registration of 4D-CT images. The subtractions of floating images and reference image before and after registration by demons further verified that influence of breathing motion cannot be ignored and the demons registration method is feasible.
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Affiliation(s)
- Hui Wang
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Academy of Medical Sciences, Jinan 250117, China.
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The influence of target and patient characteristics on the volume obtained from cone beam CT in lung stereotactic body radiation therapy. Radiother Oncol 2013; 106:312-6. [PMID: 23395064 DOI: 10.1016/j.radonc.2013.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 11/07/2012] [Accepted: 01/01/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the influence of tumor and patient characteristics on the target volume obtained from cone beam CT (CBCT) in lung stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS For a given cohort of 71 patients, the internal target volume (ITV) in CBCT obtained from four different datasets was compared with a reference ITV drawn on a four-dimensional CT (4DCT). The significance of the tumor size, location, relative target motion (RM) and patient's body mass index (BMI) and gender on the adequacy of ITV obtained from CBCT was determined. RESULTS The median ITV-CBCT was found to be smaller than the ITV-4DCT by 11.8% (range: -49.8 to +24.3%, P<0.001). Small tumors located in the lower lung were found to have a larger RM than large tumors in the upper lung. Tumors located near the central lung had high CT background which reduced the target contrast near the edges. Tumor location close to center vs. periphery was the only significant factor (P=0.046) causing underestimation of ITV in CBCT, rather than RM (P=0.323) and other factors. CONCLUSIONS The current clinical study has identified that the location of tumor is a major source of discrepancy between ITV-CBCT and ITV-4DCT for lung SBRT.
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Dunn L, Kron T, Taylor ML, Callahan J, Franich RD. A phantom for testing of 4D-CT for radiotherapy of small lesions. Med Phys 2012; 39:5372-83. [PMID: 22957605 DOI: 10.1118/1.4742053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The use of time-resolved four-dimensional computed tomography (4D-CT) in radiotherapy requires strict quality assurance to ensure the accuracy of motion management protocols. The aim of this work was to design and test a phantom capable of large amplitude motion for use in 4D-CT, with particular interest in small lesions typical for stereotactic body radiotherapy. METHODS The phantom of "see-saw" design is light weight, capable of including various sample materials and compatible with several surrogate marker signal acquisition systems. It is constructed of polymethylmethacrylate (Perspex) and its movement is controlled via a dc motor and drive wheel. It was tested using two CT scanners with different 4D acquisition methods: the Philips Brilliance Big Bore CT (helical scan, pressure belt) and a General Electric Discovery STE PET∕CT (axial scan, infrared marker). Amplitudes ranging from 1.5 to 6.0 cm and frequencies of up to 40 cycles per minute were used to study the effect of motion on image quality. Maximum intensity projections (MIPs), as well as average intensity projections (AIPs) of moving objects were investigated and their quality dependence on the number of phase reconstruction bins assessed. RESULTS CT number discrepancies between moving and stationary objects were found to have no systematic dependence on amplitude, frequency, or specific interphase variability. MIP-delineated amplitudes of motion were found to match physical phantom amplitudes to within 2 mm for all motion scenarios tested. Objects undergoing large amplitude motions (>3.0 cm) were shown to cause artefacts in MIP and AIP projections when ten phase bins were assigned. This problem can be mitigated by increasing the number of phase bins in a 4D-CT scan. CONCLUSIONS The phantom was found to be a suitable tool for evaluating the image quality of 4D-CT motion management technology, as well as providing a quality assurance tool for intercenter∕intervendor testing of commercial 4D-CT systems. When imaging objects with large amplitudes, the completeness criterion described here indicates the number of phase bins required to prevent missing data in MIPs and AIPs. This is most relevant for small lesions undergoing large motions.
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Affiliation(s)
- L Dunn
- School of Applied Sciences and Health Innovations Research Institute, RMIT University, Melbourne, Australia
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Li F, Li J, Xing J, Zhang Y, Fan T, Xu M, Shang D, Liu T, Song J. Analysis of the advantage of individual PTVs defined on axial 3D CT and 4D CT images for liver cancer. J Appl Clin Med Phys 2012; 13:4017. [PMID: 23149795 PMCID: PMC5718544 DOI: 10.1120/jacmp.v13i6.4017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 07/10/2012] [Accepted: 07/17/2012] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to compare positional and volumetric differences of planning target volumes (PTVs) defined on axial three dimensional CT (3D CT) and four dimensional CT (4D CT) for liver cancer. Fourteen patients with liver cancer underwent 3D CT and 4D CT simulation scans during free breathing. The tumor motion was measured by 4D CT. Three internal target volumes (ITVs) were produced based on the clinical target volume from 3DCT (CTV3D): i) A conventional ITV (ITVconv) was produced by adding 10 mm in CC direction and 5 mm in LR and and AP directions to CTV3D; ii) A specific ITV (ITVspec) was created using a specific margin in transaxial direction; iii) ITVvector was produced by adding an isotropic margin derived from the individual tumor motion vector. ITV4D was defined on the fusion of CTVs on all phases of 4D CT. PTVs were generated by adding a 5 mm setup margin to ITVs. The average centroid shifts between PTVs derived from 3DCT and PTV4D in left–right (LR), anterior–posterior (AP), and cranial–caudal (CC) directions were close to zero. Comparing PTV4D to PTVconv, PTVspec, and PTVvector resulted in a decrease in volume size by 33.18% ±12.39%, 24.95% ±13.01%, 48.08% ±15.32%, respectively. The mean degree of inclusions (DI) of PTV4D in PTVconv, and PTV4D in PTVspec, and PTV4D in PTVvector was 0.98, 0.97, and 0.99, which showed no significant correlation to tumor motion vector (r=‐0.470, 0.259, and 0.244; p=0.090, 0.371, and 0.401). The mean DIs of PTVconv in PTV4D, PTVspec in PTV4D, and PTVvector in PTV4D was 0.66, 0.73, and 0.52. The size of individual PTV from 4D CT is significantly less than that of PTVs from 3DCT. The position of targets derived from axial 3DCT images scatters around the center of 4D targets randomly. Compared to conventional PTV, the use of 3D CT‐based PTVs with individual margins cannot significantly reduce normal tissues being unnecessarily irradiated, but may contribute to reducing the risk of missing targets for tumors with large motion. PACS number: 87
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Affiliation(s)
- Fengxiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China
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Lee P, Kupelian P, Czernin J, Ghosh P. Current concepts in F18 FDG PET/CT-based radiation therapy planning for lung cancer. Front Oncol 2012; 2:71. [PMID: 22798989 PMCID: PMC3393879 DOI: 10.3389/fonc.2012.00071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 06/25/2012] [Indexed: 11/13/2022] Open
Abstract
Radiation therapy is an important component of cancer therapy for early stage as well as locally advanced lung cancer. The use of F18 FDG PET/CT has come to the forefront of lung cancer staging and overall treatment decision-making. FDG PET/CT parameters such as standard uptake value and metabolic tumor volume provide important prognostic and predictive information in lung cancer. Importantly, FDG PET/CT for radiation planning has added biological information in defining the gross tumor volume as well as involved nodal disease. For example, accurate target delineation between tumor and atelectasis is facilitated by utilizing PET and CT imaging. Furthermore, there has been meaningful progress in incorporating metabolic information from FDG PET/CT imaging in radiation treatment planning strategies such as radiation dose escalation based on standard uptake value thresholds as well as using respiratory-gated PET and CT planning for improved target delineation of moving targets. In addition, PET/CT-based follow-up after radiation therapy has provided the possibility of early detection of local as well as distant recurrences after treatment. More research is needed to incorporate other biomarkers such as proliferative and hypoxia biomarkers in PET as well as integrating metabolic information in adaptive, patient-centered, tailored radiation therapy.
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Affiliation(s)
- Percy Lee
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Dose-Guided Radiotherapy: Potential Benefit of Online Dose Recalculation for Stereotactic Lung Irradiation in Patients With Non-Small-Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2012; 83:e557-62. [DOI: 10.1016/j.ijrobp.2011.12.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 12/13/2011] [Accepted: 12/19/2011] [Indexed: 11/22/2022]
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Atalar B, Aydin G, Gungor G, Caglar H, Yapici B, Ozyar E. Dosimetric comparison of robotic and conventional linac-based stereotactic lung irradiation in early-stage lung cancer. Technol Cancer Res Treat 2012; 11:249-55. [PMID: 22417057 DOI: 10.7785/tcrt.2012.500293] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
We aimed to compare dosimetric characteristics of conventional linear accerator-based treatment plans to those created using the robotic CyberKnife® (CK) treatment planning system for patients with early-stage lung cancer. Eight early-stage lung cancer patients treated with stereotactic body radiotherapy (SBRT) using a conventional linac-based (LIN) system were included in this study. New treatment plans were created for the patients with the CK treatment planning system in order to compare the two platforms' dosimetric characteristics. Planning computed tomographies (CT) were obtained in three phases: free-breathing, full exhalation and inhalation. The three GTVs were then added together for internal target volume (ITV) with LIN, whereas no ITV was used for CK. Planning target volumes (PTV) were constituted by adding 5-mm margin to GTV and ITV. Treatment plan was 54 Gy in three fractions. Five-field, seven-field, and dynamic-conformal arc planning techniques were used in LIN plans. Plans were compared according to dose heterogenity (D(max)-maximum dose), volume of 54 Gy (V54) and 27 Gy isodose (V27), conformity index (CI(54) and CI(27)) and lung volumes. PTVs were significantly smaller in CK plans (p=0.012). D(max) was significantly lower in ARC plans (p=0.01). Among all plans, CK had significantly tightest isodose shell received 54 Gy and 27 Gy (p=0.0001). Among LIN plans, V54 was significantly (p=0.03) smaller in ARC plans; but no difference was observed for V27 values. LIN plans have better plan quality (CI(27) and CI(54)) than CK. No statistically significant difference was observed for lung volumes. CK plans had superior V54 and V27 values compared to LIN plans due to smaller PTV. LIN plans had better CI(27) and CI(54) values. Advantages of LIN treatment were no neccessity for fiducial marker use, which may cause pneumothorax, and significantly shorter beam-on treatment times. Both CK and LIN methods are suitable for lung SBRT.
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Affiliation(s)
- B Atalar
- Department of Radiation Oncology, Acibadem University, Istanbul, Turkey.
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Wang L, Feigenberg S, Fan J, Jin L, Turaka A, Chen L, Ma CMC. Target repositional accuracy and PTV margin verification using three-dimensional cone-beam computed tomography (CBCT) in stereotactic body radiotherapy (SBRT) of lung cancers. J Appl Clin Med Phys 2012; 13:3708. [PMID: 22402387 PMCID: PMC5716422 DOI: 10.1120/jacmp.v13i2.3708] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 11/15/2011] [Indexed: 01/08/2023] Open
Abstract
The purpose of this study was to assess target repositional accuracy with respect to the bony structures using daily CBCT, and to validate the planning target volume (PTV) margin used in the lung SBRT. All patients underwent 4D CT scanning in preparation for lung SBRT. The internal target volume (ITV) was outlined from the reconstructed 4D data using the maximum‐intensity projection (MIP) algorithm. A 6 mm margin was added to the ITV to create the PTV. Conformal treatment planning was performed on the helical images, to which the MIP images were fused. Prior to each treatment, CBCT was taken after a patient was set up in the treatment position. The CBCT images were fused with the simulation CT based on the bony anatomy, in order to derive setup errors and separate them from the tumor repositional errors. The treating physician then checked and modified the alignment based on target relocalization within the PTV. The shifts determined in such a method were recorded and the subtractions of these shifts with respect to the corresponding setup errors were defined as the target relocalization accuracy. Our study of 36 consecutive patients, treating 38 targets for a total of 153 fractions shows that, after setup error correction, the target repositional accuracy followed a normal distribution with the mean values close to 0 in all directions, and standard deviations of 0.25 cm in A–P, 0.24 cm in Lat, and 0.28 cm in S–I directions, respectively. The probability of having the shifts ≥0.6cm is less than 0.8% in A–P, 0.6% in Lat, and 1.7 % in S‐I directions. For the patient population studied, the target centroid position relative to the bony structures changed minimally from day to day. This demonstrated that the PTV margin that is designed on the MIP image‐based ITV was adequate for lung SBRT. PACS number: 87.53.Ly
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Affiliation(s)
- Lu Wang
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
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Li D, Wang H, Yin Y, Wang X. Deformable registration using edge-preserving scale space for adaptive image-guided radiation therapy. J Appl Clin Med Phys 2011; 12:3527. [PMID: 22089007 PMCID: PMC5718728 DOI: 10.1120/jacmp.v12i4.3527] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 05/09/2011] [Accepted: 05/17/2011] [Indexed: 11/23/2022] Open
Abstract
Incorporating of daily cone-beam computer tomography (CBCT) image into online radiation therapy process can achieve adaptive image-guided radiation therapy (AIGRT). Registration of planning CT (PCT) and daily CBCT are the key issues in this process. In our work, a new multiscale deformable registration method is proposed by combining edge-preserving scale space with the multilevel free-form deformation (FFD) grids for CBCT-based AIGRT system. The edge-preserving scale space, which is able to select edges and contours of images according to their geometric size, is derived from the total variation model with the L1 norm (TV-L1). At each scale, despite the noise and contrast resolution differences between the PCT and CBCT, the selected edges and contours are sufficiently strong to drive the deformation using the FFD grid, and the edge-preserving property ensures more meaningful spatial information for mutual information (MI)-based registration. At last, the deformation fields are gained by a coarse to fine manner. Furthermore, in consideration of clinical application we designed an optimal estimation of the TV-L1 parameters by minimizing the defined offset function for automated registration. Six types of patients are studied in our work, including rectum, prostate, lung, H&N (head and neck), breast, and chest cancer patients. The experiment results demonstrate the significance of the proposed method both quantitatively with ground truth known and qualitatively with ground truth unknown. The applications for AIGRT, including adaptive deformable recontouring and redosing, and DVH (dose volume histogram) analysis in the course of radiation therapy are also studied.
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Affiliation(s)
- Dengwang Li
- College of Physics and Electronics, Shandong Normal University, Ji’nan 250014, China.
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Toxicity after reirradiation of pulmonary tumours with stereotactic body radiotherapy. Radiother Oncol 2011; 101:260-6. [DOI: 10.1016/j.radonc.2011.09.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 09/15/2011] [Accepted: 09/19/2011] [Indexed: 01/20/2023]
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Wang Z, Lu X, Zhou G, Yan L, Zhang L, Zhu Y, Tian Y. Multiphase-computed tomography-based target volume definition in conventional fractionated radiotherapy of lung tumors: Dosimetric and reliable comparison with the technique using addition of generic margins. TUMORI JOURNAL 2011; 97:603-8. [DOI: 10.1177/030089161109700511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The aim of the present study was to compare radiotherapeutic plans based on internal target volume determined by between multiphase computed tomography and addition of a generic margin in lung tumors and to evaluate the reliability of ITV determined by multiphase computed tomography during conventional fractionated radiotherapy. Methods and study design The radiotherapeutic plans based on internal target volume determined by between multiphase computed tomography and addition of a generic margin in 10 patients with lung tumors were applied. The difference of two planning target volumes (PTV) and irradiated dose and volume of normal lung tissue were compared. Weekly new targets were delineated on repeated computed tomography scans, and weekly dose coverage of clinical target volume under two different treatment plans was evaluated. Results For all patients, PTV3CT volume based on multiphase computed tomography was significantly smaller than that of PTVcon based on addition of a generic margin (t = 6.831, P <0.001). The volume receiving more than 20 Gy in Plan3CT and Plancon was 16.7 ± 5.2% and 20.0 ± 5.2% (t = 7.565, P <0.001), the volume receiving more than 5 Gy was 36.6 ± 7.2% and 42.7 ± 6.4% (t = 7.459, P <0.001), and mean lung dose was 1037.5 ± 275.0 cGy and 1246.8 ± 271.0 cGy (t = 8.078, P <0.001), respectively. Both Plan3CT and Planconprovided a satisfactory clinical target volume coverage weekly during conventional fractionated radiotherapy for 6–7 weeks, and the ratio of the volume receiving the prescription dose was 1.03 ± 0.02 and 1.04 ± 0.02, respectively. Conclusions The radiotherapeutic plan based on internal target volume determined by multiphase computed tomography can ensure weekly target coverage during conventional fractionated radiotherapy in lung tumors, and it is better than the plan based on the addition of generic internal target volume, which can effectively reduce normal lung tissue irradiation.
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Affiliation(s)
- Zheng Wang
- Department of Radiation Oncology, Second Affiliated Hospital of Soochow University, Suzhou
- Department of Radiation Oncology, Changshu Affiliated Hospital of Soochow University, Suzhou, China
| | - Xueguan Lu
- Department of Radiation Oncology, Second Affiliated Hospital of Soochow University, Suzhou
| | - Gang Zhou
- Department of Radiation Oncology, Second Affiliated Hospital of Soochow University, Suzhou
| | - Liming Yan
- Department of Radiation Oncology, Second Affiliated Hospital of Soochow University, Suzhou
| | - Liyuan Zhang
- Department of Radiation Oncology, Second Affiliated Hospital of Soochow University, Suzhou
| | - Yaqun Zhu
- Department of Radiation Oncology, Second Affiliated Hospital of Soochow University, Suzhou
| | - Ye Tian
- Department of Radiation Oncology, Second Affiliated Hospital of Soochow University, Suzhou
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Gabryś D, Kulik R, Trela K, Ślosarek K. Dosimetric comparison of liver tumour radiotherapy in all respiratory phases and in one phase using 4DCT. Radiother Oncol 2011; 100:360-4. [PMID: 21974916 DOI: 10.1016/j.radonc.2011.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/03/2011] [Accepted: 09/10/2011] [Indexed: 10/17/2022]
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35
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Li FX, Li JB, Zhang YJ, Liu TH, Tian SY, Xu M, Shang DP, Ma CS. Comparison of the planning target volume based on three-dimensional CT and four-dimensional CT images of non-small-cell lung cancer. Radiother Oncol 2011; 99:176-80. [DOI: 10.1016/j.radonc.2011.03.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 03/08/2011] [Accepted: 03/27/2011] [Indexed: 10/18/2022]
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Worm ES, Hansen AT, Petersen JB, Muren LP, Præstegaard LH, Høyer M. Inter- and intrafractional localisation errors in cone-beam CT guided stereotactic radiation therapy of tumours in the liver and lung. Acta Oncol 2010; 49:1177-83. [PMID: 20590367 DOI: 10.3109/0284186x.2010.498435] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Localisation errors in cone-beam CT (CBCT) guided stereotactic body radiation therapy (SBRT) were evaluated and compared to positioning using the external coordinates of a stereotactic body frame (SBF) alone. Possible correlations to patient- or treatment-specific factors such as body mass index (BMI), planning time, treatment delivery time, and distance between tumour and spinal cord were explored to determine whether they influenced on the benefit of image-guidance. MATERIAL AND METHODS A total of 34 patients received SBRT (3 fractions) for tumours in the liver (15 patients) or the lung (19 patients). Immobilisation and positioning was obtained with a SBF. Pre- and post-treatment CBCT scans were registered with the bony anatomy of the planning CT to find inter- and intrafractional patient positioning errors (PPE). For lung tumour patients, matching was also performed on the tumours to find the tumour positioning errors (TPE) and baseline shifts relative to bony anatomy. RESULTS The mean inter- and intrafractional 3D vector PPE was 4.5 ± 2.7 mm (average ± SD) and 1.5 ± 0.6 mm, respectively, for the combined group of patients. For lung tumours, the interfractional misalignment was 5.6 ± 1.8 mm. The baseline shift was 3.9 ± 2.0 mm. Intrafractional TPE and baseline shifts were 2.1 ± 0.7 mm and 1.9 ± 0.6 mm, respectively. The magnitude of interfractional baseline shift was closely correlated with the distance between the tumour and the spinal cord. Intrafractional errors were independent of patient BMI, age or gender. CONCLUSION Image-guidance reduced setup errors considerably. The study demonstrated the benefit of CBCT-guidance regardless of patient specific factors such as BMI, age or gender. Protection of the spinal cord was facilitated by the correlation between the tumour position relative to the spinal cord and the magnitude of baseline shift.
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Affiliation(s)
- Esben S Worm
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark.
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Bettinardi V, Picchio M, Di Muzio N, Gianolli L, Gilardi MC, Messa C. Detection and compensation of organ/lesion motion using 4D-PET/CT respiratory gated acquisition techniques. Radiother Oncol 2010; 96:311-6. [PMID: 20708809 DOI: 10.1016/j.radonc.2010.07.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 07/14/2010] [Accepted: 07/15/2010] [Indexed: 12/25/2022]
Abstract
PURPOSE To describe the degradation effects produced by respiratory organ and lesion motion on PET/CT images and to define the role of respiratory gated (RG) 4D-PET/CT techniques to compensate for such effects. METHODS Based on the literature and on our own experience, technical recommendations and clinical indications for the use of RG 4D PET/CT have been outlined. RESULTS RG 4D-PET/CT techniques require a state of the art PET/CT scanner, a respiratory monitoring system and dedicated acquisition and processing protocols. Patient training is particularly important to obtain a regular breathing pattern. An adequate number of phases has to be selected to balance motion compensation and statistical noise. RG 4D PET/CT motion free images may be clinically useful for tumour tissue characterization, monitoring patient treatment and target definition in radiation therapy planning. CONCLUSIONS RG 4D PET/CT is a valuable tool to improve image quality and quantitative accuracy and to assess and measure organ and lesion motion for radiotherapy planning.
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Adaptive radiation for lung cancer. JOURNAL OF ONCOLOGY 2010; 2011. [PMID: 20814539 PMCID: PMC2931378 DOI: 10.1155/2011/898391] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 06/24/2010] [Indexed: 12/25/2022]
Abstract
The challenges of lung cancer radiotherapy are intra/inter-fraction tumor/organ anatomy/motion changes and the
need to spare surrounding critical structures. Evolving radiotherapy technologies, such as four-dimensional (4D) image-based motion management, daily on-board imaging and adaptive radiotherapy based on volumetric images over the course of radiotherapy, have enabled us to deliver higher dose to target while minimizing normal tissue toxicities. The image-guided radiotherapy adapted to changes of motion and anatomy has made the radiotherapy more precise and allowed ablative dose delivered to the target using novel treatment approaches such as intensity-modulated radiation therapy, stereotactic body radiation therapy, and proton therapy in lung cancer, techniques used to be considered very sensitive to motion change. Future clinical trials using real time tracking and biological adaptive radiotherapy based on functional images are proposed.
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Huang L, Park K, Boike T, Lee P, Papiez L, Solberg T, Ding C, Timmerman RD. A study on the dosimetric accuracy of treatment planning for stereotactic body radiation therapy of lung cancer using average and maximum intensity projection images. Radiother Oncol 2010; 96:48-54. [PMID: 20430460 DOI: 10.1016/j.radonc.2010.04.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 04/05/2010] [Accepted: 04/05/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the accuracy of current stereotactic body radiation therapy (SBRT) lung treatment planning methodologies on irregular breathing patterns, we have performed a systematic dosimetric evaluation in phantoms by utilizing maximum intensity projection (MIP) and average (AVG) images generated from four dimensional computed tomography (4DCT). METHODS A custom built programmable lung phantom was used to simulate tumor motions due to various breathing patterns of patients. 4DCT scans were obtained in helical mode, and reconstructed AVG and MIP datasets were imported into the Pinnacle 8.0 h treatment planning system. SBRT plans were generated and executed, and delivered doses were measured by radiochromic film for analysis. RESULTS For targets moving regularly or irregularly within a small range (7.0+/-1.8 mm, n=6), we observed good agreement between the measured and computed dose distributions. However, for targets moving irregularly with a larger range (20.8+/-2.6 mm, n=4), the measured isodose lines were found to be shifted relative to the planned distribution, resulting in an under-dosing (over 10%) in a portion of the PTV. We further observed that the discrepancy between planned and measured dose distribution is due to the inaccurate representation of irregular target motion in the MIP images generated from 4DCT. CONCLUSIONS Caution should be used when planning from 4DCT images in the presence of large and irregular target motion. The inaccuracy inherent in 4DCT MIP and AVG images can be mitigated through the application of methodologies to reduce respiratory motion, such as abdominal compression, and through the use of volumetric image guidance (e.g., cone beam CT-CBCT) to assure precise targeting with minimal shifts.
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Affiliation(s)
- Long Huang
- Department Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9183, USA
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Thwaites DI, Verellen D. Vorsprung durch Technik: evolution, implementation, QA and safety of new technology in radiotherapy. Radiother Oncol 2010; 94:125-8. [PMID: 20170973 DOI: 10.1016/j.radonc.2010.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 02/09/2010] [Indexed: 11/18/2022]
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Chi A, Liao Z, Nguyen NP, Xu J, Stea B, Komaki R. Systemic review of the patterns of failure following stereotactic body radiation therapy in early-stage non-small-cell lung cancer: clinical implications. Radiother Oncol 2010; 94:1-11. [PMID: 20074823 DOI: 10.1016/j.radonc.2009.12.008] [Citation(s) in RCA: 265] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Revised: 11/23/2009] [Accepted: 12/17/2009] [Indexed: 12/22/2022]
Abstract
PURPOSE To analyze the patterns of failure, the toxicity profile, and the factors influencing efficacy of stereotactic body radiation (SBRT) for early-stage non-small-cell lung cancer (NSCLC). METHODS AND MATERIALS A search was based on PubMed electronic databases. All searches were conducted in May, 2009. RESULTS The local control ranged from 80% to 100% in most studies with adequate isocentric or peripheral biologically effective dose (BED). Recurrences were associated with increased tumor size. The main pattern of failure after SBRT was distant metastasis. Grades 3-5 toxicity occurred mostly in centrally located tumors, and adjuvant chemotherapy may further decrease all recurrences; possibly translating to a survival benefit in large or centrally located tumors where high BED cannot be safely reached. CONCLUSION SBRT is an excellent treatment option for early-stage, and mostly medically inoperable, NSCLC. BED at both the isocenter and the tumor periphery is very important for optimal tumor control; higher doses are required for large (T2) lesions; SBRT for centrally located tumors can be feasible with a much less aggressive dose regimen than 60-66Gy/3 fractions and adjacent critical structures excluded from the target volume; chemotherapy may optimize the clinical outcome in large or centrally located lesions.
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Affiliation(s)
- Alexander Chi
- Department of Radiation Oncology, University of Arizona, 1501 N Campbell Ave., Tucson, AZ 85724, USA.
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Hof H, Rhein B, Haering P, Kopp-Schneider A, Debus J, Herfarth K. 4D-CT-based target volume definition in stereotactic radiotherapy of lung tumours: Comparison with a conventional technique using individual margins. Radiother Oncol 2009; 93:419-23. [PMID: 19782418 DOI: 10.1016/j.radonc.2009.08.040] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 08/24/2009] [Accepted: 08/25/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Holger Hof
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
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Baumann M, Zips D, Appold S. Radiotherapy of lung cancer: Technology meets biology meets multidisciplinarity. Radiother Oncol 2009; 91:279-81. [DOI: 10.1016/j.radonc.2009.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 05/07/2009] [Indexed: 11/26/2022]
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Dinkel J, Hintze C, Tetzlaff R, Huber PE, Herfarth K, Debus J, Kauczor HU, Thieke C. 4D-MRI analysis of lung tumor motion in patients with hemidiaphragmatic paralysis. Radiother Oncol 2009; 91:449-54. [PMID: 19394712 DOI: 10.1016/j.radonc.2009.03.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Revised: 03/13/2009] [Accepted: 03/19/2009] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the complex breathing patterns in patients with hemidiaphragmatic paralysis due to malignant infiltration using four-dimensional magnetic resonance imaging (4D-MRI). PATIENTS AND METHODS Seven patients with bronchial carcinoma infiltrating the phrenic nerve were examined using 1.5 T MRI. The motion of the tumor and of both hemi-diaphragms were measured on dynamic 2D TrueFISP and 4D FLASH MRI sequences. RESULTS For each patient, 3-6 breathing cycles were recorded. The respiratory-induced mean cranio-caudal displacement of the tumor was 6.6 mm (+/-2.8 SD). The mean displacement anterior-posterior was 7.4 mm (+/-2.6), while right-left movement was about 7.4 mm (+/-4.5). The mediastinum moved sidewards during inspiration, realizing a "mediastinal shift". The paralyzed hemidiaphragm and the tumor showed a paradox motion during respiration in five patients. In two patients, the affected hemidiaphragm had a regular, however minimal and asynchronous motion during respiration. Respiratory variability of both tumor and diaphragm motions was about 20% although patients were instructed to breath normally. The findings showed significant differences compared to breathing patterns of patients without diaphragm dysfunction. CONCLUSION 4D-MRI is a promising tool to analyze complex breathing patterns in patients with lung tumors. It should be considered for use in planning of radiotherapy to account for individual tumor motion.
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Affiliation(s)
- Julien Dinkel
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
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