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van Timmeren JE, Bussink J, Koopmans P, Smeenk RJ, Monshouwer R. Longitudinal Image Data for Outcome Modeling. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00277-2. [PMID: 39003124 DOI: 10.1016/j.clon.2024.06.053] [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: 10/23/2023] [Revised: 04/15/2024] [Accepted: 06/24/2024] [Indexed: 07/15/2024]
Abstract
In oncology, medical imaging is crucial for diagnosis, treatment planning and therapy execution. Treatment responses can be complex and varied and are known to involve factors of treatment, patient characteristics and tumor microenvironment. Longitudinal image analysis is able to track temporal changes, aiding in disease monitoring, treatment evaluation, and outcome prediction. This allows for the enhancement of personalized medicine. However, analyzing longitudinal 2D and 3D images presents unique challenges, including image registration, reliable segmentation, dealing with variable imaging intervals, and sparse data. This review presents an overview of techniques and methodologies in longitudinal image analysis, with a primary focus on outcome modeling in radiation oncology.
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Affiliation(s)
- J E van Timmeren
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - J Bussink
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - P Koopmans
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - R J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - R Monshouwer
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
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Lorenzo Polo A, Nix M, Thompson C, O'Hara C, Entwisle J, Murray L, Appelt A, Weistrand O, Svensson S. Improving hybrid image and structure-based deformable image registration for large internal deformations. Phys Med Biol 2024; 69:095011. [PMID: 38518382 DOI: 10.1088/1361-6560/ad3723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/22/2024] [Indexed: 03/24/2024]
Abstract
Objective.Deformable image registration (DIR) is a widely used technique in radiotherapy. Complex deformations, resulting from large anatomical changes, are a regular challenge. DIR algorithms generally seek a balance between capturing large deformations and preserving a smooth deformation vector field (DVF). We propose a novel structure-based term that can enhance the registration efficacy while ensuring a smooth DVF.Approach.The proposed novel similarity metric for controlling structures was introduced as a new term into a commercially available algorithm. Its performance was compared to the original algorithm using a dataset of 46 patients who received pelvic re-irradiation, many of which exhibited complex deformations.Main results.The mean Dice Similarity Coefficient (DSC) under the improved algorithm was 0.96, 0.94, 0.76, and 0.91 for bladder, rectum, colon, and bone respectively, compared to 0.69, 0.89, 0.62, and 0.88 for the original algorithm. The improvement was more pronounced for complex deformations.Significance.With this work, we have demonstrated that the proposed term is able to improve registration accuracy for complex cases while maintaining realistic deformations.
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Affiliation(s)
| | - M Nix
- Leeds Cancer Centre, Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - C Thompson
- Leeds Cancer Centre, Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - C O'Hara
- Leeds Cancer Centre, Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - J Entwisle
- Leeds Cancer Centre, Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - L Murray
- Leeds Cancer Centre, Department of Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom
| | - A Appelt
- Leeds Cancer Centre, Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom
| | - O Weistrand
- RaySearch Laboratories, SE-104 30 Stockholm, Sweden
| | - S Svensson
- RaySearch Laboratories, SE-104 30 Stockholm, Sweden
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Yun S, Jeong U, Lee D, Kim H, Cho S. Image quality improvement in bowtie-filter-equipped cone-beam CT using a dual-domain neural network. Med Phys 2023; 50:7498-7512. [PMID: 37669510 DOI: 10.1002/mp.16693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND The bowtie-filter in cone-beam CT (CBCT) causes spatially nonuniform x-ray beam often leading to eclipse artifacts in the reconstructed image. The artifacts are further confounded by the patient scatter, which is therefore patient-dependent as well as system-specific. PURPOSE In this study, we propose a dual-domain network for reducing the bowtie-filter-induced artifacts in CBCT images. METHODS In the projection domain, the network compensates for the filter-induced beam-hardening that are highly related to the eclipse artifacts. The output of the projection-domain network was used for image reconstruction and the reconstructed images were fed into the image-domain network. In the image domain, the network further reduces the remaining cupping artifacts that are associated with the scatter. A single image-domain-only network was also implemented for comparison. RESULTS The proposed approach successfully enhanced soft-tissue contrast with much-reduced image artifacts. In the numerical study, the proposed method decreased perceptual loss and root-mean-square-error (RMSE) of the images by 84.5% and 84.9%, respectively, and increased the structure similarity index measure (SSIM) by 0.26 compared to the original input images on average. In the experimental study, the proposed method decreased perceptual loss and RMSE of the images by 87.2% and 92.1%, respectively, and increased SSIM by 0.58 compared to the original input images on average. CONCLUSIONS We have proposed a deep-learning-based dual-domain framework to reduce the bowtie-filter artifacts and to increase the soft-tissue contrast in CBCT images. The performance of the proposed method has been successfully demonstrated in both numerical and experimental studies.
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Affiliation(s)
- Sungho Yun
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Uijin Jeong
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Donghyeon Lee
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Hyeongseok Kim
- KAIST Institute for Artificial Intelligence, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Seungryong Cho
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
- KAIST Institute for Artificial Intelligence, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
- KAIST Institute for Health Science and Technology, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
- KAIST Institute for IT Convergence, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
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Adachi T, Nakamura M, Iramina H, Matsumoto K, Ishihara Y, Tachibana H, Kurokawa S, Cho S, Tanaka K, Fukumoto K, Nishiyama T, Kito S, Mizowaki T. Identification of reproducible radiomic features from on-board volumetric images: A multi-institutional phantom study. Med Phys 2023; 50:5585-5596. [PMID: 36932977 DOI: 10.1002/mp.16376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Radiomics analysis using on-board volumetric images has attracted research attention as a method for predicting prognosis during treatment; however, the lack of standardization is still one of the main concerns. PURPOSE This study investigated the factors that influence the reproducibility of radiomic features extracted from on-board volumetric images using an anthropomorphic radiomics phantom. Furthermore, a phantom experiment was conducted with different treatment machines from multiple institutions as external validation to identify reproducible radiomic features. METHODS The phantom was designed to be 35 × 20 × 20 cm with eight types of heterogeneous spheres (⌀ = 1, 2, and 3 cm). On-board volumetric images were acquired using 15 treatment machines from eight institutions. Of these, kilovoltage cone-beam computed tomography (kV-CBCT) image data acquired from four treatment machines at one institution were used as an internal evaluation dataset to explore the reproducibility of radiomic features. The remaining image data, including kV-CBCT, megavoltage-CBCT (MV-CBCT), and megavoltage computed tomography (MV-CT) provided by seven different institutions (11 treatment machines), were used as an external validation dataset. A total of 1,302 radiomic features, including 18 first-order, 75 texture, 465 (i.e., 93 × 5) Laplacian of Gaussian (LoG) filter-based, and 744 (i.e., 93 × 8) wavelet filter-based features, were extracted within the spheres. The intraclass correlation coefficient (ICC) was calculated to explore feature repeatability and reproducibility using an internal evaluation dataset. Subsequently, the coefficient of variation (COV) was calculated to validate the feature variability of external institutions. An absolute ICC exceeding 0.85 or COV under 5% was considered indicative of a highly reproducible feature. RESULTS For internal evaluation, ICC analysis showed that the median percentage of radiomic features with high repeatability was 95.2%. The ICC analysis indicated that the median percentages of highly reproducible features for inter-tube current, reconstruction algorithm, and treatment machine were decreased by 20.8%, 29.2%, and 33.3%, respectively. For external validation, the COV analysis showed that the median percentage of reproducible features was 31.5%. A total of 16 features, including nine LoG filter-based and seven wavelet filter-based features, were indicated as highly reproducible features. The gray-level run-length matrix (GLRLM) was classified as containing the most frequent features (N = 8), followed by the gray-level dependence matrix (N = 7) and gray-level co-occurrence matrix (N = 1) features. CONCLUSIONS We developed the standard phantom for radiomics analysis of kV-CBCT, MV-CBCT, and MV-CT images. With this phantom, we revealed that the differences in the treatment machine and image reconstruction algorithm reduce the reproducibility of radiomic features from on-board volumetric images. Specifically, the most reproducible features for external validation were LoG or wavelet filter-based GLRLM features. However, the acceptability of the identified features should be examined in advance at each institution before applying the findings to prognosis prediction.
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Affiliation(s)
- Takanori Adachi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto, Japan
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Hiraku Iramina
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Kazushige Matsumoto
- Department of Radiology, National Hospital Organization Kyoto Medical Center, Fushimi-ku, Kyoto, Japan
| | - Yoshitomo Ishihara
- Department of Radiation Oncology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Hidenobu Tachibana
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shogo Kurokawa
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - SangYong Cho
- Division of Radiation Oncology, Chiba Cancer Center, Chuo-ku, Chiba, Japan
| | - Kazunori Tanaka
- Department of Radiation Oncology, Kyoto City Hospital, Nakagyo-ku, Kyoto, Japan
| | - Kenta Fukumoto
- Department of Radiation Oncology, Kyoto City Hospital, Nakagyo-ku, Kyoto, Japan
| | - Tomohiro Nishiyama
- Department of Radiation Oncology, Kyoto-Katsura Hospital, Nishikyo-ku, Kyoto, Japan
| | - Satoshi Kito
- Department of Radiotherapy, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto, Japan
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Sellami S, Bourbonne V, Hatt M, Tixier F, Bouzid D, Lucia F, Pradier O, Goasduff G, Visvikis D, Schick U. Predicting response to radiotherapy of head and neck squamous cell carcinoma using radiomics from cone-beam CT images. Acta Oncol 2022; 61:73-80. [PMID: 34632924 DOI: 10.1080/0284186x.2021.1983207] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Radiotherapy (RT) for head and neck cancer is now guided by cone-beam computed tomography (CBCT). We aim to identify a CBCT radiomic signature predictive of progression to RT. MATERIAL AND METHODS A cohort of 93 patients was split into training (n = 60) and testing (n = 33) sets. A total of 88 features were extracted from the gross tumor volume (GTV) on each CBCT. Receiver operating characteristic (ROC) curves were used to determine the power of each feature at each week of treatment to predict progression to radio(chemo)therapy. Only features with AUC > 0.65 at each week were pre-selected. Absolute differences were calculated between features from each weekly CBCT and baseline CBCT1 images. The smallest detectable change (C = 1.96 × SD, SD being the standard deviation of differences between feature values calculated on CBCT1 and CBCTn) with its confidence interval (95% confidence interval [CI]) was determined for each feature. The features for which the change was larger than C for at least 5% of patients were then selected. A radiomics-based model was built at the time-point that showed the highest AUC and compared with models relying on clinical variables. RESULTS Seven features had an AUC > 0.65 at each week, and six exhibited a change larger than the predefined CI 95%. After exclusion of inter-correlated features, only one parameter remains, Coarseness. Among clinical variable, only hemoglobin value was significant. AUC for predicting the treatment response were 0.78 (p = .006), 0.85 (p < .001), and 0.99 (p < .001) for clinical, CBCT4-radiomics (Coarseness) and clinical + radiomics based models respectively. The mean AUC of this last model on a 5-fold cross-validation was 0.80 (±0.09). On the testing cohort, the best prediction was given by the combined model (balanced accuracy [BAcc] 0.67 , p < .001). CONCLUSIONS We described a feature selection methodology for delta-radiomics that is able to select reproducible features which are informative due to their change during treatment. A selected delta radiomics feature may improve clinical-based prediction models.
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Affiliation(s)
- S. Sellami
- Radiation Oncology Department, University Hospital, Brest, France
| | - V. Bourbonne
- Radiation Oncology Department, University Hospital, Brest, France
| | - M. Hatt
- INSERM, UMR 1101, LaTIM, University of Brest, Brest, France
| | - F. Tixier
- INSERM, UMR 1101, LaTIM, University of Brest, Brest, France
| | - D. Bouzid
- INSERM, UMR 1101, LaTIM, University of Brest, Brest, France
| | - F. Lucia
- Radiation Oncology Department, University Hospital, Brest, France
- INSERM, UMR 1101, LaTIM, University of Brest, Brest, France
| | - O. Pradier
- Radiation Oncology Department, University Hospital, Brest, France
- INSERM, UMR 1101, LaTIM, University of Brest, Brest, France
- Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France
| | - G. Goasduff
- Radiation Oncology Department, University Hospital, Brest, France
| | - D. Visvikis
- INSERM, UMR 1101, LaTIM, University of Brest, Brest, France
| | - U. Schick
- Radiation Oncology Department, University Hospital, Brest, France
- INSERM, UMR 1101, LaTIM, University of Brest, Brest, France
- Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France
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Piperdi H, Portal D, Neibart SS, Yue NJ, Jabbour SK, Reyhan M. Adaptive Radiation Therapy in the Treatment of Lung Cancer: An Overview of the Current State of the Field. Front Oncol 2021; 11:770382. [PMID: 34912715 PMCID: PMC8666420 DOI: 10.3389/fonc.2021.770382] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/09/2021] [Indexed: 12/25/2022] Open
Abstract
Lung cancer treatment is constantly evolving due to technological advances in the delivery of radiation therapy. Adaptive radiation therapy (ART) allows for modification of a treatment plan with the goal of improving the dose distribution to the patient due to anatomic or physiologic deviations from the initial simulation. The implementation of ART for lung cancer is widely varied with limited consensus on who to adapt, when to adapt, how to adapt, and what the actual benefits of adaptation are. ART for lung cancer presents significant challenges due to the nature of the moving target, tumor shrinkage, and complex dose accumulation because of plan adaptation. This article presents an overview of the current state of the field in ART for lung cancer, specifically, probing topics of: patient selection for the greatest benefit from adaptation, models which predict who and when to adapt plans, best timing for plan adaptation, optimized workflows for implementing ART including alternatives to re-simulation, the best radiation techniques for ART including magnetic resonance guided treatment, algorithms and quality assurance, and challenges and techniques for dose reconstruction. To date, the clinical workflow burden of ART is one of the major reasons limiting its widespread acceptance. However, the growing body of evidence demonstrates overwhelming support for reduced toxicity while improving tumor dose coverage by adapting plans mid-treatment, but this is offset by the limited knowledge about tumor control. Progress made in predictive modeling of on-treatment tumor shrinkage and toxicity, optimizing the timing of adaptation of the plan during the course of treatment, creating optimal workflows to minimize staffing burden, and utilizing deformable image registration represent ways the field is moving toward a more uniform implementation of ART.
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Affiliation(s)
- Huzaifa Piperdi
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Daniella Portal
- Rutgers Robert Wood Johnson Medical School, Rutgers, The State of New Jersey University, Piscataway, NJ, United States
| | - Shane S. Neibart
- Rutgers Robert Wood Johnson Medical School, Rutgers, The State of New Jersey University, Piscataway, NJ, United States
| | - Ning J. Yue
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Salma K. Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
- Rutgers Robert Wood Johnson Medical School, Rutgers, The State of New Jersey University, Piscataway, NJ, United States
| | - Meral Reyhan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
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Du F, Liu H, Wang W, Zhang Y, Li J. Correlation Between Lung Density Changes Under Different Dose Gradients and Radiation Pneumonitis-Based on an Analysis of Computed Tomography Scans During Esophageal Cancer Radiotherapy. Front Oncol 2021; 11:650764. [PMID: 34123799 PMCID: PMC8187904 DOI: 10.3389/fonc.2021.650764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To assess the relationship between different doses of radiation and lung density changes and to determine the ability of this correlation to identify esophageal cancer (EC) patients who develop radiation pneumonitis (RP) and the occurrence time of RP. Methods A planning computed tomography (CT) scan and a re-planning CT scan were retrospectively collected under institutional review board approval for each of 103 thoracic segment EC patients who underwent radiotherapy (RT). The isodose curve was established on the planning CT with an interval of 5 Gy, which was used as the standard for dividing different gradient doses. Planning CT and re-planning CT scans were matched and the mean lung CT value (HU) between different doses gradients was automatically obtained by the software system. The density change value (ΔHU) was the difference of CT value between each dose gradient before and after treatment. The correlation between ΔHU and the corresponding dose was calculated, as well as the regression coefficients. Additionally the correlation between ΔHU and the occurrence and time of RP (< 4 weeks, 4-12 weeks, > 12 weeks) was calculated. Results The radiation dose and ΔHU was positively correlated, but the correlation coefficient and regression coefficient were lower, 0.261 (P <0.001) and 0.127 (P <0.001), respectively. With the increase of radiation dose gradient, ΔHU in RP≥2 group was higher than that in RP<2 group, and there was significant difference between two groups in ΔHU20-25, ΔHU25-30, ΔHU30-35, ΔHU35-40, ΔHU40-45, ΔHU45-50 (p<0.05). The occurrence time of RP was negatively correlated with the degree of ΔHU (P<0.05), with a high correlation coefficient (Y = week actual value -0.521, P < 0.001) (Y = week grade value -0.381, P = 0.004) and regression coefficient (Y = week actual value -0.503, P<0.001) (Y = week rating value -0.401, P=0.002). Conclusions A relationship between radiation dose and lung density changes was observed. For most dose intervals, there was an increase of ΔHU with an increased radiation dose, although low correlation coefficient. ΔHU were obvious after irradiation with dose ≥20 Gy which was closely related to the occurrence of RP. For patients with RP, the more obvious ΔHU, the earlier the occurrence of RP, there was a significant negative correlation between them.
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Affiliation(s)
- Feng Du
- School of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Radiation Oncology, Zibo Municipal Hospital, Zibo, China
| | - Hong Liu
- Department of Radiation Oncology, Zibo Municipal Hospital, Zibo, China
| | - Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Palani D, Shanmugam S, Govindaraj K. Analysing the possibility of utilizing CBCT radiomics as an independent modality: a phantom study. Asian Pac J Cancer Prev 2021; 22:1383-1391. [PMID: 34048165 PMCID: PMC8408395 DOI: 10.31557/apjcp.2021.22.5.1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Indexed: 11/25/2022] Open
Abstract
Aim: To verify if computed tomography (CT) radiomics were reproducible by cone beam CT (CBCT) radiomics by using Catphan® 504. Materials and Methods: Catphan® 504 was imaged using the default IGRT OBI CBCT imaging protocols and CT scanner. Seven known density image regions of the phantom were segmented and image feature was extracted by Imaging Biomarker Explorer (IBEX) software. The 49 selected features from four feature categories were analyzed by considering each region of interest (ROI) segment as individual image set. Correlation was studies using interclass correlation coefficient (ICC) and Pearson’s correlation coefficient. Results: The ICC of the three feature categories, namely intensity, GLCM, and GLRLM was significant (p-value<0.05) in comparison with CT, while the ICC of the fourth feature category, NID, was no significant. The average absolute Pearson’s correlation coefficient from the features of the images was as follows: CT: r=0.679±0.257, CBCThead: r=0.707±0.231, CBCTthorax: r=0.643±0.260, and CBCTpelvis: r=0.594±0.276. Conclusion: It seems that the various densities of Catphan® 504 ROI image segments of the CT radiomics are reproducible with CBCT radiomics and CBCT radiomics can be used as an independent modality.
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Affiliation(s)
- Dharmendran Palani
- Research and Development Centre, Bharathiar University, Coimbatore, India
| | - Senthilkumar Shanmugam
- Department of Radiotherapy Government Rajaji Hospital & Madurai Medical College, Madurai, Tamil Nadu, India
| | - Kesavan Govindaraj
- Research and Development Centre, Bharathiar University, Coimbatore, India.,Department of Radiotherapy, Vadamalayan Hospitals Integrated Cancer Centre, Madurai, India
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Qin Q, Shi A, Zhang R, Wen Q, Niu T, Chen J, Qiu Q, Wan Y, Sun X, Xing L. Cone-beam CT radiomics features might improve the prediction of lung toxicity after SBRT in stage I NSCLC patients. Thorac Cancer 2020; 11:964-972. [PMID: 32061061 PMCID: PMC7113065 DOI: 10.1111/1759-7714.13349] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/15/2022] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) is the standard care for inoperable early stage non‐small cell lung cancer (NSCLC). The purpose of our study was to investigate whether a prediction model based on cone‐beam CT (CBCT) plus pretreatment CT radiomics features could improve the prediction of tumor control and lung toxicity after SBRT in comparison to a model based on pretreatment CT radiomics features alone. Methods A total of 34 cases of stage I NSCLC patients who received SBRT were included in the study. The pretreatment planning CT and serial CBCT radiomics features were analyzed using the imaging biomarker explorer (IBEX) software platform. Multivariate logistic regression was conducted for the association between progression‐free survival (PFS), lung toxicity and features. The predictive capabilities of the models based on CBCT and CT features were compared using receiver operating characteristic (ROC) curves. Results Five CBCT features and two planning CT features were correlated with disease progression. Six CBCT features and two planning CT features were related to lung injury. The ROC curves indicated that the model based on the CBCT plus planning CT features might be better than the model based on the planning CT features in predicting lung injury. The other ROC curves indicated that the model based on the planning CT features was similar to the model based on the CBCT plus planning CT features in predicting disease progression. Conclusions Both pretreatment CT and CBCT radiomics features could predict disease progression and lung injury. A model with CBCT plus pretreatment CT radiomics features might improve the prediction of lung toxicity in comparison with a model with pretreatment CT features alone. Key points Significant findings of the study: A model with cone‐beam CT radiomics features plus pre‐treatment CT radiomics features might improve the prediction of lung toxicity after SBRT in stage I NSCLC patients. What this study adds: In the prediction of PFS and lung toxicity in early‐stage NSCLC patients treated with SBRT, CBCT radiomics could be another effective method.
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Affiliation(s)
- Qingjin Qin
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Anhui Shi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China.,Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ran Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China.,Shandong University Cheeloo College of Medicine, Jinan, China
| | - Qiang Wen
- Department of Oncology, Shandong Provincial Hospital, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Tianye Niu
- Nuclear & Radiological Engineering and Medical Physics Programs Woodruff School of Mechanical Engineering Georgia Institute of Technology, Atlanta, Georgia
| | - Jinhu Chen
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Qingtao Qiu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Yidong Wan
- Institute of Translational Medicine, Zhejiang University, Hangzhou, Zhejiang
| | - Xiaorong Sun
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China.,Shandong University Cheeloo College of Medicine, Jinan, China.,Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Ligang Xing
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
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Defraene G, van Elmpt W, De Ruysscher D. Regional lung avoidance by CT numbers to reduce radiation-induced lung damage risk in non-small-cell lung cancer: a simulation study. Acta Oncol 2020; 59:201-207. [PMID: 31549562 DOI: 10.1080/0284186x.2019.1669814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Selective avoidance aims at sparing functional lung regions. Here, we preferentially direct radiation to irreversibly nonfunctional lung areas based on planning CT imaging to reduce functional lung damage.Materials and methods: For 12 stage I-IV NSCLC patients, 5 lung substructures were segmented on the planning CT, combining voxels <-900HU, -900HU to -801HU, -800HU to -701HU, -700HU to -601HU and ≥-600HU (Level 1 to 5). Two VMAT plans were optimized: a reference plan blinded from substructures and a selective avoidance plan (AV) imposing gradually stricter constraints on Level 1-5, based on previously validated associations between lung subvolume baseline density and density increase (ΔHU) after treatment. Characteristics of treatment plans were evaluated, including subvolumes, dose, and predicted ΔHU (with reported 95% CI reflecting prediction model uncertainty).Results: Segmented substructures were on average 477 cc, 1157 cc, 484 cc, 69 cc, and 123 cc (Level 1-5). AV plans could spare Level 3-5, e.g., mean dose decrease of 3.5 Gy (range 0.6 Gy; 6.0 Gy) for Level 5, p<.001. This significantly reduced the average lung mass with predicted ΔHU>20HU by 12.5 g (95% CI: 5.4-16.9) and 27.1 g (95% CI: 10.2-32.9) for a median and upper 10th percentile patient susceptibility for damage simulation, respectively.Conclusions: Lung damage avoidance based on CT density is feasible and easy to implement. A biomarker providing a reliable selection of patients with high susceptibility for lung damage will be crucial to show the clinical relevance of this avoidance planning strategy.
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Affiliation(s)
- Gilles Defraene
- Department of Oncology, Experimental Radiation Oncology, KU Leuven—University of Leuven, Leuven, Belgium
| | - Wouter van Elmpt
- Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center, GROW School for Developmental Biology and Oncology, Maastricht, The Netherlands
| | - Dirk De Ruysscher
- Department of Oncology, Experimental Radiation Oncology, KU Leuven—University of Leuven, Leuven, Belgium
- Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center, GROW School for Developmental Biology and Oncology, Maastricht, The Netherlands
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Mututantri-Bastiyange D, C. L. Chow J. Imaging dose of cone-beam computed tomography in nanoparticle-enhanced image-guided radiotherapy: A Monte Carlo phantom study. AIMS BIOENGINEERING 2020. [DOI: 10.3934/bioeng.2020001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Schröder C, Engenhart-Cabillic R, Kirschner S, Blank E, Buchali A. Changes of lung parenchyma density following high dose radiation therapy for thoracic carcinomas - an automated analysis of follow up CT scans. Radiat Oncol 2019; 14:72. [PMID: 31036015 PMCID: PMC6489276 DOI: 10.1186/s13014-019-1276-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background An objective way to qualify the effect of radiotherapy (RT) on lung tissue is the analysis of CT scans after RT. In this analysis we focused on the changes in Hounsfield units (ΔHU) and the correlation with the corresponding radiation dose after RT. Methods Pre- and post-RT CT scans were matched and ΔHU was calculated using customized research software. ΔHU was calculated in 5-Gy-intervals and the correlation between ΔHU and the corresponding dose was calculated as well as the regression coefficients. Additionally the mean ΔHU and ΔHU in 5-Gy-intervals were calculated for each tumor entity. Results The mean density changes at 12 weeks and 6 months post RT were 28,16 HU and 32,83 HU. The correlation coefficient between radiation dose and ΔHU at 12 weeks and 6 months were 0,166 (p = 0,000) and 0,158 (p = 0,000). The resulting regression coefficient were 1439 HU/Gy (p = 0,000) and 1612 HU/Gy (p = 0,000). The individual regression coefficients for each patient range from − 2,23 HU/Gy to 7,46 HU/Gy at 12 weeks and − 0,45 HU/Gy to 10,51 HU/Gy at 6 months. When looking at the three tumor entities individually the highest ΔHU at 12 weeks was seen in patients with SCLC (38,13 HU) and at 6 month in those with esophageal carcinomas (40,98 HU). Conclusion For most dose intervals there was an increase of ΔHU with an increased radiation dose. This is reflected by a statistically significant, although low correlation coefficient. The regression coefficients of all patients show large interindividual differences.
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Affiliation(s)
- Christina Schröder
- Clinic for Radiotherapy and Radiation Oncology, University Clinic Giessen and Marburg, Marburg, Germany. .,Clinic for Radiation Oncology, Universitätsspital Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland.
| | - Rita Engenhart-Cabillic
- Clinic for Radiotherapy and Radiation Oncology, University Clinic Giessen and Marburg, Marburg, Germany
| | - Sven Kirschner
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - Eyck Blank
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - André Buchali
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
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van Timmeren JE, van Elmpt W, Leijenaar RTH, Reymen B, Monshouwer R, Bussink J, Paelinck L, Bogaert E, De Wagter C, Elhaseen E, Lievens Y, Hansen O, Brink C, Lambin P. Longitudinal radiomics of cone-beam CT images from non-small cell lung cancer patients: Evaluation of the added prognostic value for overall survival and locoregional recurrence. Radiother Oncol 2019; 136:78-85. [PMID: 31015133 PMCID: PMC6598851 DOI: 10.1016/j.radonc.2019.03.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/07/2019] [Accepted: 03/29/2019] [Indexed: 11/23/2022]
Abstract
Longitudinal CBCT radiomics does not show added prognostic information for NSCLC. A CT-radiomics model could be validated in an external validation dataset. Dataset heterogeneity and small cohort sizes could cause poor validation performance.
Background and purpose The prognostic value of radiomics for non-small cell lung cancer (NSCLC) patients has been investigated for images acquired prior to treatment, but no prognostic model has been developed that includes the change of radiomic features during treatment. Therefore, the aim of this study was to investigate the potential added prognostic value of a longitudinal radiomics approach using cone-beam computed tomography (CBCT) for NSCLC patients. Materials and methods This retrospective study includes a training dataset of 141 stage I–IV NSCLC patients and three external validation datasets of 94, 61 and 41 patients, all treated with curative intended (chemo)radiotherapy. The change of radiomic features extracted from CBCT images was summarized as the slope of a linear regression. The CBCT slope-features and CT-extracted features were used as input for a Cox proportional hazards model. Moreover, prognostic performance of clinical parameters was investigated for overall survival and locoregional recurrence. Model performances were assessed using the Kaplan–Meier curves and c-index. Results The radiomics model contained only CT-derived features and reached a c-index of 0.63 for overall survival and could be validated on the first validation dataset. No model for locoregional recurrence could be developed that validated on the validation datasets. The clinical parameters model could not be validated for either overall survival or locoregional recurrence. Conclusion In this study we could not confirm our hypothesis that longitudinal CBCT-extracted radiomic features contribute to improved prognostic information. Moreover, performance of baseline radiomic features or clinical parameters was poor, probably affected by heterogeneity within and between datasets.
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Affiliation(s)
- Janna E van Timmeren
- The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands
| | - Ralph T H Leijenaar
- The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Bart Reymen
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands
| | - René Monshouwer
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johan Bussink
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Leen Paelinck
- Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Evelien Bogaert
- Ghent University Hospital and Ghent University, Ghent, Belgium
| | | | - Elamin Elhaseen
- Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Yolande Lievens
- Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Olfred Hansen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Carsten Brink
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Philippe Lambin
- The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Functional lung imaging in radiation therapy for lung cancer: A systematic review and meta-analysis. Radiother Oncol 2018; 129:196-208. [PMID: 30082143 DOI: 10.1016/j.radonc.2018.07.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/14/2018] [Accepted: 07/18/2018] [Indexed: 12/25/2022]
Abstract
RATIONALE Advanced imaging techniques allow functional information to be derived and integrated into treatment planning. METHODS A systematic review was conducted with the primary objective to evaluate the ability of functional lung imaging to predict risk of radiation pneumonitis. Secondary objectives were to evaluate dose-response relationships on post treatment functional imaging and assess the utility in including functional lung information into treatment planning. A structured search for publications was performed following PRISMA guidelines and registered on PROSPERO. RESULTS 814 articles were screened against review criteria and 114 publications met criteria. Methods of identifying functional lung included using CT, MRI, SPECT and PET to image ventilation or perfusion. Six studies compared differences between functional and anatomical lung imaging at predicting radiation pneumonitis. These found higher predictive values using functional lung imaging. Twenty-one studies identified a dose-response relationship on post-treatment functional lung imaging. Nineteen planning studies demonstrated the ability of functional lung optimised planning techniques to spare regions of functional lung. Meta-analysis of these studies found that mean (95% CI) functional volume receiving 20 Gy was reduced by 4.2% [95% CI: 2.3: 6.0] and mean lung dose by 2.2 Gy [95% CI: 1.2: 3.3] when plans were optimised to spare functional lung. There was significant variation between publications in the definition of functional lung. CONCLUSION Functional lung imaging may have potential utility in radiation therapy planning and delivery, although significant heterogeneity was identified in approaches and reporting. Recommendations have been made based on the available evidence for future functional lung trials.
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Defraene G, La Fontaine M, van Kranen S, Reymen B, Belderbos J, Sonke JJ, De Ruysscher D. Radiation-Induced Lung Density Changes on CT Scan for NSCLC: No Impact of Dose-Escalation Level or Volume. Int J Radiat Oncol Biol Phys 2018; 102:642-650. [PMID: 30244882 DOI: 10.1016/j.ijrobp.2018.06.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/23/2018] [Accepted: 06/20/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Dose-escalation for patients with non-small cell lung cancer (NSCLC) in the positron emission tomography (PET)-boost trial (NCT01024829) exposes portions of normal lung tissue to high radiation doses. The relationship between lung parenchyma dose and density changes on computed tomography (CT) was analyzed. MATERIALS AND METHODS The CT scans of 59 patients with stage IB to III NSCLC, randomized between a boost to the whole primary tumor and an integrated boost to its 50% SUVmax (maximum standardized uptake value) volume. Patients were treated with concurrent or sequential chemoradiation or radiation only. Deformable registration mapped the 3-month follow-up CT to the planning CT. Hounsfield unit differences (ΔHU) were extracted to assess lung parenchyma density changes. Equivalent dose in 2 Gy fractions (EQD2)-ΔHU response was described sigmoidally, and regional response variation was studied by polar analysis. Prognostic factors of ΔHU were obtained through generalized linear modeling. RESULTS Saturation of ΔHU was observed above 60 Gy. No interaction was found between boost dose distribution (D1cc and V70Gy) and ΔHU at lower doses. ΔHU was lowest peripherally from the tumor and peaked posteriorly at 3 cm from the tumor border (3.1 HU/Gy). Right lung location was an independent risk factor for ΔHU (P = .02). CONCLUSIONS No apparent increase of lung density changes at 3-month follow-up was observed above 60 Gy EQD2 for patients with NSCLC treated with (concurrent or sequential chemo) radiation. The mild response observed peripherally in the lung parenchyma might be exploited in plan optimization routines minimizing lung damage.
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Affiliation(s)
- Gilles Defraene
- Department of Oncology, Experimental Radiation Oncology, KU Leuven-University of Leuven, Belgium.
| | - Matthew La Fontaine
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon van Kranen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bart Reymen
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - José Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dirk De Ruysscher
- Department of Oncology, Experimental Radiation Oncology, KU Leuven-University of Leuven, Belgium; Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiation Oncology (Maastro Clinic), GROW School for Developmental Biology and Oncology, Maastricht, The Netherlands
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Kierkels RGJ, den Otter LA, Korevaar EW, Langendijk JA, van der Schaaf A, Knopf AC, Sijtsema NM. An automated, quantitative, and case-specific evaluation of deformable image registration in computed tomography images. Phys Med Biol 2018; 63:045026. [PMID: 29182154 DOI: 10.1088/1361-6560/aa9dc2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A prerequisite for adaptive dose-tracking in radiotherapy is the assessment of the deformable image registration (DIR) quality. In this work, various metrics that quantify DIR uncertainties are investigated using realistic deformation fields of 26 head and neck and 12 lung cancer patients. Metrics related to the physiologically feasibility (the Jacobian determinant, harmonic energy (HE), and octahedral shear strain (OSS)) and numerically robustness of the deformation (the inverse consistency error (ICE), transitivity error (TE), and distance discordance metric (DDM)) were investigated. The deformable registrations were performed using a B-spline transformation model. The DIR error metrics were log-transformed and correlated (Pearson) against the log-transformed ground-truth error on a voxel level. Correlations of r ⩾ 0.5 were found for the DDM and HE. Given a DIR tolerance threshold of 2.0 mm and a negative predictive value of 0.90, the DDM and HE thresholds were 0.49 mm and 0.014, respectively. In conclusion, the log-transformed DDM and HE can be used to identify voxels at risk for large DIR errors with a large negative predictive value. The HE and/or DDM can therefore be used to perform automated quality assurance of each CT-based DIR for head and neck and lung cancer patients.
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Bissonnette JP, Yap ML, Clarke K, Shessel A, Higgins J, Vines D, Atenafu EG, Becker N, Leavens C, Bezjak A, Jaffray DA, Sun A. Serial 4DCT/4DPET imaging to predict and monitor response for locally-advanced non-small cell lung cancer chemo-radiotherapy. Radiother Oncol 2018; 126:347-354. [DOI: 10.1016/j.radonc.2017.11.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/07/2017] [Accepted: 11/27/2017] [Indexed: 12/12/2022]
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Jensen KR, Brink C, Hansen O, Bernchou U. Ventilation measured on clinical 4D-CBCT: Increased ventilation accuracy through improved image quality. Radiother Oncol 2017; 125:459-463. [DOI: 10.1016/j.radonc.2017.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/05/2017] [Accepted: 10/17/2017] [Indexed: 12/25/2022]
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van Timmeren JE, Leijenaar RTH, van Elmpt W, Reymen B, Lambin P. Feature selection methodology for longitudinal cone-beam CT radiomics. Acta Oncol 2017; 56:1537-1543. [PMID: 28826307 DOI: 10.1080/0284186x.2017.1350285] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cone-beam CT (CBCT) scans are typically acquired daily for positioning verification of non-small cell lung cancer (NSCLC) patients. Quantitative information, derived using radiomics, can potentially contribute to (early) treatment adaptation. The aims of this study were to (1) describe and investigate a methodology for feature selection of a longitudinal radiomics approach (2) investigate which time-point during treatment is potentially useful for early treatment response assessment. MATERIAL AND METHODS For 90 NSCLC patients CBCT scans of the first two fractions of treatment (considered as 'test-retest' scans) were analyzed, as well as weekly CBCT images. One hundred and sixteen radiomic features were extracted from the GTV of all scans and subsequently absolute and relative differences were calculated between weekly CBCT images and the CBCT of the first fraction. Test-retest scans were used to determine the smallest detectable change (C = 1.96 * SD) allowing for feature selection by choosing a minimum number of patients for which a feature should change more than 'C' to be considered as relevant. Analysis of which features change at which moment during treatment was used to investigate which time-point is potentially relevant to extract longitudinal radiomics information for early treatment response assessment. RESULTS A total of six absolute delta features changed for at least ten patients at week 2 of treatment and increased to 61 at week 3, 79 at week 4 and 85 at week 5. There was 93% overlap between features selected at week 3 and the other weeks. CONCLUSIONS This study describes a feature selection methodology for longitudinal radiomics that is able to select reproducible delta radiomics features that are informative due to their change during treatment, which can potentially be used for treatment decisions concerning adaptive radiotherapy. Nonetheless, the prognostic value of the selected delta radiomic features should be investigated in future studies.
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Affiliation(s)
- Janna E. van Timmeren
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Ralph T. H. Leijenaar
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Bart Reymen
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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Kaliyaperumal V, Raphael CJ, Varghese KM, Gopu P, Sivakumar S, Boban M, Raj NAN, Senthilnathan K, Babu PR. Study of Variation in Dose Calculation Accuracy Between kV Cone-Beam Computed Tomography and kV fan-Beam Computed Tomography. J Med Phys 2017; 42:171-180. [PMID: 28974864 PMCID: PMC5618465 DOI: 10.4103/jmp.jmp_24_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/15/2017] [Accepted: 06/20/2017] [Indexed: 02/06/2023] Open
Abstract
Cone-beam computed tomography (CBCT) images are presently used for geometric verification for daily patient positioning. In this work, we have compared the images of CBCT with the images of conventional fan beam CT (FBCT) in terms of image quality and Hounsfield units (HUs). We also compared the dose calculated using CBCT with that of FBCT. Homogenous RW3 plates and Catphan phantom were scanned by FBCT and CBCT. In RW3 and Catphan phantom, percentage depth dose (PDD), profiles, isodose distributions (for intensity modulated radiotherapy plans), and calculated dose volume histograms were compared. The HU difference was within ± 20 HU (central region) and ± 30 HU (peripheral region) for homogeneous RW3 plates. In the Catphan phantom, the difference in HU was ± 20 HU in the central area and peripheral areas. The HU differences were within ± 30 HU for all HU ranges starting from -1000 to 990 in phantom and patient images. In treatment plans done with simple symmetric and asymmetric fields, dose difference (DD) between CBCT plan and FBCT plan was within 1.2% for both phantoms. In intensity modulated radiotherapy (IMRT) treatment plans, for different target volumes, the difference was <2%. This feasibility study investigated HU variation and dose calculation accuracy between FBCT and CBCT based planning and has validated inverse planning algorithms with CBCT. In our study, we observed a larger deviation of HU values in the peripheral region compared to the central region. This is due to the ring artifact and scatter contribution which may prevent the use of CBCT as the primary imaging modality for radiotherapy treatment planning. The reconstruction algorithm needs to be modified further for improving the image quality and accuracy in HU values. However, our study with TG-119 and intensity modulated radiotherapy test targets shows that CBCT can be used for adaptive replanning as the recalculation of dose with the anisotropic analytical algorithm is in full accord with conventional planning CT except in the build-up regions. Patient images with CBCT have to be carefully analyzed for any artifacts before using them for such dose calculations.
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Affiliation(s)
| | - C. Jomon Raphael
- Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - K. Mathew Varghese
- Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Paul Gopu
- Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - S. Sivakumar
- Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Minu Boban
- Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - N. Arunai Nambi Raj
- Centre for Biomaterials, Cellular and Molecular Theranostics, VIT University, Vellore, Tamil Nadu, India
| | - K. Senthilnathan
- Department of Physics, School of Advanced Sciences VIT University, Vellore, Tamil Nadu, India
| | - P. Ramesh Babu
- Department of Physics, School of Advanced Sciences VIT University, Vellore, Tamil Nadu, India
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van Timmeren JE, Leijenaar RT, van Elmpt W, Reymen B, Oberije C, Monshouwer R, Bussink J, Brink C, Hansen O, Lambin P. Survival prediction of non-small cell lung cancer patients using radiomics analyses of cone-beam CT images. Radiother Oncol 2017; 123:363-369. [DOI: 10.1016/j.radonc.2017.04.016] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/20/2017] [Accepted: 04/17/2017] [Indexed: 01/20/2023]
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Regional variability in radiation-induced lung damage can be predicted by baseline CT numbers. Radiother Oncol 2017; 122:300-306. [DOI: 10.1016/j.radonc.2016.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/24/2016] [Accepted: 11/26/2016] [Indexed: 12/25/2022]
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Accuracy of dose calculation based on artefact corrected Cone Beam CT images of lung cancer patients. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2017. [DOI: 10.1016/j.phro.2016.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nielsen MK, Malkoske KE, Brown E, Diamond K, Frenière N, Grant J, Pomerleau-Dalcourt N, Schella J, Schreiner LJ, Tantôt L, Villareal-Barajas JE, Bissonnette JP. Production, review, and impact of technical quality control guidelines in a national context. J Appl Clin Med Phys 2016; 17:3-15. [PMID: 27929477 PMCID: PMC5690511 DOI: 10.1120/jacmp.v17i6.6422] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/24/2016] [Accepted: 06/21/2016] [Indexed: 11/23/2022] Open
Abstract
A close partnership between the Canadian Partnership for Quality Radiotherapy (CPQR) and the Canadian Organization of Medical Physicist's (COMP) Quality Assurance and Radiation Safety Advisory Committee (QARSAC) has resulted in the development of a suite of Technical Quality Control (TQC) guidelines for radiation treatment equipment; they outline specific performance objectives and criteria that equipment should meet in order to assure an acceptable level of radiation treatment quality. The adopted framework for the development and maintenance of the TQCs ensures the guidelines incorporate input from the medical physics community during development, measures the workload required to perform the QC tests outlined in each TQC, and remain relevant (i.e., “living documents”) through subsequent planned reviews and updates. The framework includes consolidation of existing guidelines and/or literature by expert reviewers, structured stages of public review, external field‐testing, and ratification by COMP. This TQC development framework is a cross‐country initiative that allows for rapid development of robust, community‐driven living guideline documents that are owned by the community and reviewed to keep relevant in a rapidly evolving technical environment. Community engagement and uptake survey data shows 70% of Canadian centers are part of this process and that the data in the guideline documents reflect, and are influencing, the way Canadian radiation treatment centers run their technical quality control programs. For a medium‐sized center comprising six linear accelerators and a comprehensive brachytherapy program, we evaluate the physics workload to 1.5 full‐time equivalent physicists per year to complete all QC tests listed in this suite. PACS number(s): 87.55.Qr, 87.56.Fc, 87.56.‐v
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Affiliation(s)
- Michelle K Nielsen
- Mississauga Halton/Central West Regional Cancer Program, Trillium Health Partners.
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Thing RS, Bernchou U, Mainegra-Hing E, Hansen O, Brink C. Hounsfield unit recovery in clinical cone beam CT images of the thorax acquired for image guided radiation therapy. Phys Med Biol 2016; 61:5781-802. [DOI: 10.1088/0031-9155/61/15/5781] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Szeto YZ, Witte MG, van Kranen SR, Sonke JJ, Belderbos J, van Herk M. Effects of anatomical changes on pencil beam scanning proton plans in locally advanced NSCLC patients. Radiother Oncol 2016; 120:286-92. [PMID: 27393217 DOI: 10.1016/j.radonc.2016.04.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/02/2016] [Accepted: 04/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Daily anatomical variations can cause considerable differences between delivered and planned dose. This study simulates and evaluates these effects in spot-scanning proton therapy for lung cancer patients. MATERIALS AND METHODS Robust intensity modulated treatment plans were designed on the mid-position CT scan for sixteen locally advanced lung cancer patients. To estimate dosimetric uncertainty, deformable registration was performed on their daily CBCTs to generate 4DCT equivalent scans for each fraction and to map recomputed dose to a common frame. RESULTS Without adaptive planning, eight patients had an undercoverage of the targets of more than 2GyE (maximum of 14.1GyE) on the recalculated treatment dose from the daily anatomy variations including respiration. In organs at risk, a maximum increase of 4.7GyE in the D1 was found in the mediastinal structures. The effect of respiratory motion alone is smaller: 1.4GyE undercoverage for targets and less than 1GyE for organs at risk. CONCLUSIONS Daily anatomical variations over the course of treatment can cause considerable dose differences in the robust planned dose distribution. An advanced planning strategy including knowledge of anatomical uncertainties would be recommended to improve plan robustness against interfractional variations. For large anatomical changes, adaptive therapy is mandatory.
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Affiliation(s)
- Yenny Z Szeto
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marnix G Witte
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon R van Kranen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - José Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marcel van Herk
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Open source deformable image registration system for treatment planning and recurrence CT scans : Validation in the head and neck region. Strahlenther Onkol 2016; 192:545-51. [PMID: 27323754 DOI: 10.1007/s00066-016-0998-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clinical application of deformable registration (DIR) of medical images remains limited due to sparse validation of DIR methods in specific situations, e. g. in case of cancer recurrences. In this study the accuracy of DIR for registration of planning CT (pCT) and recurrence CT (rCT) images of head and neck squamous cell carcinoma (HNSCC) patients was evaluated. PATIENTS AND MATERIALS Twenty patients treated with definitive IMRT for HNSCC in 2010-2012 were included. For each patient, a pCT and an rCT scan were used. Median interval between the scans was 8.5 months. One observer manually contoured eight anatomical regions-of-interest (ROI) twice on pCT and once on rCT. METHODS pCT and rCT images were deformably registered using the open source software elastix. Mean surface distance (MSD) and Dice similarity coefficient (DSC) between contours were used for validation of DIR. A measure for delineation uncertainty was estimated by assessing MSD from the re-delineations of the same ROI on pCT. DIR and manual contouring uncertainties were correlated with tissue volume and rigidity. RESULTS MSD varied 1-3 mm for different ROIs for DIR and 1-1.5 mm for re-delineated ROIs performed on pCT. DSC for DIR varied between 0.58 and 0.79 for soft tissues and was 0.79 or higher for bony structures, and correlated with the volumes of ROIs (r = 0.5, p < 0.001) and tissue rigidity (r = 0.54, p < 0.001). CONCLUSION DIR using elastix in HNSCC on planning and recurrence CT scans is feasible; an uncertainty of the method is close to the voxel size length of the planning CT images.
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Kipritidis J, Hofman MS, Siva S, Callahan J, Le Roux PY, Woodruff HC, Counter WB, Keall PJ. Estimating lung ventilation directly from 4D CT Hounsfield unit values. Med Phys 2015; 43:33. [DOI: 10.1118/1.4937599] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Bernchou U, Hansen O, Schytte T, Bertelsen A, Hope A, Moseley D, Brink C. Prediction of lung density changes after radiotherapy by cone beam computed tomography response markers and pre-treatment factors for non-small cell lung cancer patients. Radiother Oncol 2015; 117:17-22. [DOI: 10.1016/j.radonc.2015.07.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/30/2015] [Accepted: 07/16/2015] [Indexed: 12/25/2022]
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Defraene G, van Elmpt W, Crijns W, Slagmolen P, De Ruysscher D. CT characteristics allow identification of patient-specific susceptibility for radiation-induced lung damage. Radiother Oncol 2015; 117:29-35. [DOI: 10.1016/j.radonc.2015.07.033] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/18/2015] [Accepted: 07/25/2015] [Indexed: 12/25/2022]
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Brink C, Bernchou U, Bertelsen A, Hansen O, Schytte T, Bentzen SM. In reply to Yamazaki et al. Int J Radiat Oncol Biol Phys 2015; 91:245-6. [PMID: 25835632 DOI: 10.1016/j.ijrobp.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Carsten Brink
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Uffe Bernchou
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Anders Bertelsen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Olfred Hansen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Soren M Bentzen
- Division of Biostatistics and Bioinformatics, University of Maryland Greenebaum Cancer Center, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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Weistrand O, Svensson S. The ANACONDA algorithm for deformable image registration in radiotherapy. Med Phys 2014; 42:40-53. [PMID: 25563246 DOI: 10.1118/1.4894702] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Ola Weistrand
- RaySearch Laboratories AB, Sveavägen 44, SE-11134 Stockholm, Sweden
| | - Stina Svensson
- RaySearch Laboratories AB, Sveavägen 44, SE-11134 Stockholm, Sweden
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Srinivasan K, Mohammadi M, Shepherd J. Applications of linac-mounted kilovoltage Cone-beam Computed Tomography in modern radiation therapy: A review. Pol J Radiol 2014; 79:181-93. [PMID: 25006356 PMCID: PMC4085117 DOI: 10.12659/pjr.890745] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 03/27/2014] [Indexed: 11/23/2022] Open
Abstract
The use of Cone-beam Computed Tomography (CBCT) in radiotherapy is increasing due to the widespread implementation of kilovoltage systems on the currently available linear accelerators. Cone beam CT acts as an effective Image-Guided Radiotherapy (IGRT) tool for the verification of patient position. It also opens up the possibility of real-time re-optimization of treatment plans for Adaptive Radiotherapy (ART). This paper reviews the most prominent applications of CBCT (linac-mounted) in radiation therapy, focusing on CBCT-based planning and dose calculation studies. This is followed by a concise review of the main issues associated with CBCT, such as imaging artifacts, dose and image quality. It explores how medical physicists and oncologists can best apply CBCT for therapeutic applications.
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Affiliation(s)
- Kavitha Srinivasan
- School of Chemistry and Physics, University of Adelaide, Adelaide, Australia
| | - Mohammad Mohammadi
- School of Chemistry and Physics, University of Adelaide, Adelaide, Australia ; Department of Medical Physics, Royal Adelaide Hospital, Adelaide, Australia
| | - Justin Shepherd
- Department of Medical Physics, Royal Adelaide Hospital, Adelaide, Australia
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Brink C, Bernchou U, Bertelsen A, Hansen O, Schytte T, Bentzen SM. Locoregional control of non-small cell lung cancer in relation to automated early assessment of tumor regression on cone beam computed tomography. Int J Radiat Oncol Biol Phys 2014; 89:916-23. [PMID: 24867537 DOI: 10.1016/j.ijrobp.2014.03.038] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/18/2014] [Accepted: 03/21/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE Large interindividual variations in volume regression of non-small cell lung cancer (NSCLC) are observable on standard cone beam computed tomography (CBCT) during fractionated radiation therapy. Here, a method for automated assessment of tumor volume regression is presented and its potential use in response adapted personalized radiation therapy is evaluated empirically. METHODS AND MATERIALS Automated deformable registration with calculation of the Jacobian determinant was applied to serial CBCT scans in a series of 99 patients with NSCLC. Tumor volume at the end of treatment was estimated on the basis of the first one third and two thirds of the scans. The concordance between estimated and actual relative volume at the end of radiation therapy was quantified by Pearson's correlation coefficient. On the basis of the estimated relative volume, the patients were stratified into 2 groups having volume regressions below or above the population median value. Kaplan-Meier plots of locoregional disease-free rate and overall survival in the 2 groups were used to evaluate the predictive value of tumor regression during treatment. Cox proportional hazards model was used to adjust for other clinical characteristics. RESULTS Automatic measurement of the tumor regression from standard CBCT images was feasible. Pearson's correlation coefficient between manual and automatic measurement was 0.86 in a sample of 9 patients. Most patients experienced tumor volume regression, and this could be quantified early into the treatment course. Interestingly, patients with pronounced volume regression had worse locoregional tumor control and overall survival. This was significant on patient with non-adenocarcinoma histology. CONCLUSIONS Evaluation of routinely acquired CBCT images during radiation therapy provides biological information on the specific tumor. This could potentially form the basis for personalized response adaptive therapy.
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Affiliation(s)
- Carsten Brink
- Institute of Clinical Research, University of Southern Denmark, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Denmark.
| | - Uffe Bernchou
- Institute of Clinical Research, University of Southern Denmark, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Denmark
| | - Anders Bertelsen
- Laboratory of Radiation Physics, Odense University Hospital, Denmark
| | - Olfred Hansen
- Institute of Clinical Research, University of Southern Denmark, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Denmark
| | - Soren M Bentzen
- Division of Biostatistics and Bioinformatics, University of Maryland Greenebaum Cancer Center, and Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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Grau C, Høyer M, Alber M, Overgaard J, Lindegaard JC, Muren LP. Biology-guided adaptive radiotherapy (BiGART)--more than a vision? Acta Oncol 2013; 52:1243-7. [PMID: 23984809 DOI: 10.3109/0284186x.2013.829245] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Cai Grau
- Department of Oncology, Aarhus University Hospital , Aarhus , Denmark
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Time evolution of regional CT density changes in normal lung after IMRT for NSCLC. Radiother Oncol 2013; 109:89-94. [PMID: 24060177 DOI: 10.1016/j.radonc.2013.08.041] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 08/20/2013] [Accepted: 08/25/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE This study investigates the clinical radiobiology of radiation induced lung disease in terms of regional computed tomography (CT) density changes following intensity modulated radiotherapy (IMRT) for non-small-cell lung cancer (NSCLC). METHODS A total of 387 follow-up CT scans in 131 NSCLC patients receiving IMRT to a prescribed dose of 60 or 66 Gy in 2 Gy fractions were analyzed. The dose-dependent temporal evolution of the density change was analyzed using a two-component model, a superposition of an early, transient component and a late, persistent component. RESULTS The CT density of healthy lung tissue was observed to increase significantly (p<0.0001) for all dose levels after IMRT. The time evolution and the size of the density signal depend on the local delivered dose. The transient component of the density signal was found to peak in the range of 3-4 months, while the density tends to stabilize at times >12 months. CONCLUSIONS The radiobiology of lung injury may be analyzed in terms of CT density change. The initial transient change in density is consistent with radiation pneumonitis, while the subsequent stabilization of the density is consistent with pulmonary fibrosis.
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Bertelsen A, Hansen O, Brink C. Does VMAT for treatment of NSCLC patients increase the risk of pneumonitis compared to IMRT ? - a planning study. Acta Oncol 2012; 51:752-8. [PMID: 22248064 DOI: 10.3109/0284186x.2011.648341] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Volumetric modulated arc therapy (VMAT) for treatment of non-small cell lung cancer (NSCLC) patients potentially changes the risk of radiation-induced pneumonitis (RP) compared to intensity modulated radiation therapy (IMRT) if the dose to the healthy lung is changed significantly. In this study, clinical IMRT plans were used as starting point for VMAT optimization and differences in risk estimates of RP between the two plan types were evaluated. MATERIAL AND METHODS Fifteen NSCLC patients prescribed 66 Gy in 2 Gy fractions were planned with IMRT and subsequently with single arc VMAT. Dose metrics were evaluated for target and lung together with population averaged dose volume histograms. The risk of RP was calculated using normal tissue complication probability (NTCP) models. Finally, applicability of the plans was tested through delivery on an Elekta accelerator. RESULTS When changing from IMRT to VMAT only modest differences were observed in the dose to the lung and target volume. On average, fractions of lung irradiated to doses between 18 Gy and 48 Gy were statistically significant reduced using VMAT compared to IMRT. For the fraction of lung receiving more than 20 Gy the reduction was 1.2% percentage points: (range -0.6 -2.6%). The evaluated toxicity were smaller with VMAT compared to IMRT, however only modest differences were observed in the NTCP values. The plans were delivered without any problems. The average beam on time with VMAT was 83 s. This was a reduction of 141 s (ranging from 37 s to 216 s) compared to IMRT. CONCLUSIONS Using IMRT as reference for the VMAT optimization it was possible to implement VMAT in the clinic with no increase in estimated risk of RP. Thus, toxicity is not expected to be a hindrance to using VMAT and will profit from the shorter delivery time with VMAT compared to IMRT.
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Affiliation(s)
- Anders Bertelsen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
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De Ruysscher D, van Baardwijk A, Steevens J, Botterweck A, Bosmans G, Reymen B, Wanders R, Borger J, Dingemans AMC, Bootsma G, Pitz C, Lunde R, Geraedts W, Oellers M, Dekker A, Lambin P. Individualised isotoxic accelerated radiotherapy and chemotherapy are associated with improved long-term survival of patients with stage III NSCLC: A prospective population-based study. Radiother Oncol 2012; 102:228-33. [DOI: 10.1016/j.radonc.2011.10.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 10/19/2011] [Accepted: 10/20/2011] [Indexed: 12/25/2022]
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De Ruysscher D, van Elmpt W, Lambin P. Radiotherapy with curative intent for lung cancer: A continuing success story. Radiother Oncol 2011; 101:237-9. [DOI: 10.1016/j.radonc.2011.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 10/27/2011] [Indexed: 12/25/2022]
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40
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Thwaites DI, Malicki J. Physics and technology in ESTRO and in Radiotherapy and Oncology: past, present and into the 4th dimension. Radiother Oncol 2011; 100:327-32. [PMID: 21962819 DOI: 10.1016/j.radonc.2011.09.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 09/21/2011] [Indexed: 12/11/2022]
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