1
|
Optimization of a protocol for contrast-enhanced four-dimensional computed tomography imaging of thoracic tumors using minimal contrast agent. Strahlenther Onkol 2021; 197:1021-1031. [PMID: 34476528 PMCID: PMC8547213 DOI: 10.1007/s00066-021-01836-8] [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: 04/12/2021] [Accepted: 08/01/2021] [Indexed: 12/04/2022]
Abstract
Purpose The accuracy of target delineation for node-positive thoracic tumors is dependent on both four-dimensional computed tomography (4D-CT) and contrast-enhanced three-dimensional (3D)-CT images; these scans enable the motion visualization of tumors and delineate the nodal areas. Combining the two techniques would be more effective; however, currently, there is no standard protocol for the contrast media injection parameters for contrast-enhanced 4D-CT (CE-4D-CT) scans because of its long scan durations and complexity. Thus, we aimed to perform quantitative and qualitative assessments of the image quality of single contrast-enhanced 4D-CT scans to simplify this process and improve the accuracy of target delineation in order to replace the standard clinical modality involved in administering radiotherapy for thoracic tumors. Methods Ninety consecutive patients with thoracic tumors were randomly and parallelly assigned to one of nine subgroups subjected to CE-4D-CT scans with the administration of contrast agent volume equal to the patient’s weight but different flow rate and scan delay time (protocol A1: flow rate of 2.0 ml/s, delay time of 15 s; A2: 2.0 ml/s, 20 s; A3: 2.0 ml/s, 25 s; B1: 2.5 ml/s, 15 s; B2: 2.5 ml/s, 20 s; B3: 2.5 ml/s, 25 s; C1: 3.0 ml/s, 15 s; C2: 3.0 ml/s, 20 s; C3: 3.0 ml/s, 25 s). The Hounsfield unit (HU) values of the thoracic aorta, pulmonary artery stem, pulmonary veins, carotid artery, and jugular vein were acquired for each protocol. Both quantitative and qualitative image analysis and delineation acceptability were assessed. Results The results revealed significant differences among the nine protocols. Enhancement of the vascular structures in mediastinal and perihilar regions was more effective with protocol A1 or A2; however, when interested in the region of superior mediastinum and supraclavicular fossa, protocol C2 or C3 is recommended. Conclusion Qualitatively acceptable enhancement on contrast-enhanced 4D-CT images of thoracic tumors can be obtained by varying the flow rate and delay time when minimal contrast agent is used.
Collapse
|
2
|
New Data-Driven Gated PET/CT Free of Misregistration Artifacts. Int J Radiat Oncol Biol Phys 2021; 109:1638-1646. [PMID: 33186619 DOI: 10.1016/j.ijrobp.2020.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We developed a new data-driven gated (DDG) positron emission tomography (PET)/computed tomography (CT) to improve the registration of CT and DDG PET. METHODS We acquired 10 repeat PET/CT and 35 cine CT scans for the mitigation of misregistration between CT and PET data. We also derived end-expiration phase CT as DDG CT for attenuation correction of DDG PET. Radiation exposure, body mass index (BMI), scan coverage, and effective radiation dose were compared between repeat PET/CT and cine CT. Of the 35 cine CT patients, 14 (capturing 59 total tumors) were compared among average PET/CT (baseline PET attenuation correction by average CT), DDG PET (DDG PET attenuation correction by baseline CT), and DDG PET/CT (DDG PET attenuation correction by DDG CT) for registration and quantification without increasing the scan time for DDG PET. RESULTS Compared with repeat PET/CT, cine CT had significantly lower scan coverage (32.5 ± 11.5 cm vs 15.4 ± 4.7 cm; P < .001) and effective radiation dose (3.7 ± 2.6 mSv vs 1.3 ± 0.6 mSv; P < .01). Repeat PET/CT and cine CT did not differ significantly in BMI or radiation exposure (P > .1). Cine CT saved the scan time for not needing a repeat PET. The SUV ratios of average PET/CT, DDG PET, and DDG PET/CT to baseline PET/CT were 1.14 ± 0.28, 1.28 ± 0.20, and 1.63 ± 0.64, respectively (P < .0001), suggesting that the SUVmax increased consecutively from baseline PET/CT to average PET/CT, DDG PET, and DDG PET/CT. Motion correction with DDG PET had a larger impact on quantification than registration improvement with average CT did. The biggest improvement in quantification was from DDG PET/CT, in which both registration was improved and motion was mitigated. CONCLUSION Our new DDG PET/CT approach alleviates misregistration artifacts and, compared with DDG PET, improves quantification and registration. The use of cine CT in our DDG PET/CT method also reduces the effective radiation dose and scan coverage compared with repeat CT.
Collapse
|
3
|
Su M, Gong G, Qiu X, Tong Y, Li Q, Yin Y. Study on the Effect of 4D-CT Special Reconstruction Images for Evaluation of the Cardiac Structure Dose in Radiotherapy for Breast Cancer. Front Oncol 2020; 10:433. [PMID: 32300558 PMCID: PMC7145401 DOI: 10.3389/fonc.2020.00433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/11/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ming Su
- School of Nuclear Science and Technology, University of South China, Hengyang, China
| | - Guanzhong Gong
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiaoping Qiu
- School of Nuclear Science and Technology, University of South China, Hengyang, China
| | - Ying Tong
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qian Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yong Yin
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Yong Yin
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Yan Y, Lu Z, Liu Z, Luo W, Shao S, Tan L, Ma X, Liu J, Drokow EK, Ren J. Dosimetric comparison between three- and four-dimensional computerised tomography radiotherapy for breast cancer. Oncol Lett 2019; 18:1800-1814. [PMID: 31423248 PMCID: PMC6607180 DOI: 10.3892/ol.2019.10467] [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: 04/17/2018] [Accepted: 04/12/2019] [Indexed: 02/07/2023] Open
Abstract
At present, methods of radiotherapy simulation for breast cancer based on four-dimensional computerised tomography (4D-CT) or three-dimensional CT (3D-CT) simulation remain controversial. In the present study, 7 patients with residual breast tissue received whole breast radiotherapy based on 3D-CT and 4D-CT simulation. For the 4D-CT plan, four types of CT images were produced, including images of the end of inspiration and the end of expiration, and images acquired by the maximal intensity projection (MIP) and average intensity projection (AIP). In the 3D-CT plan, the clinical target volume (CTV) and plan target volume (PTV) were marginally higher compared with the 4D-CT plan. In addition, the minimum point dose of the target volume (Dmin), the maximum point dose of the target volume (Dmax) and the mean point dose of the target volume (Dmean) of the CTV and PTV in the MIP and AIP plans were marginally higher compared with the 3D-CT plan. For the contralateral breast (C-B), volumes of the 4D-CT plan were markedly lower compared with the 3D-CT plan. Furthermore, Dmin, Dmax and Dmean of the 3D-CT plan were higher compared with the AIP and MIP plans. For the ipsilateral lungs (I-L), volumes of the 3D-CT and AIP plans were higher compared with the MIP plan. Furthermore, when breast lesions were on the left side, for the heart, the volume receiving no less than 40% of the prescription dose (V40) and the volume receiving no less than 30% of the prescription dose (V30) of the MIP and AIP plans were slightly lower compared with those of the 3D plan. In conclusion, 4D-CT radiotherapy based on the MIP and AIP plans provides a slightly smaller radiation area and slightly higher radiotherapy dosage of the CTV and PTV compared with 3D-CT radiotherapy for breast radiotherapy. Therefore, the MIP and AIP plans prevent C-B radiation exposure and improve sparing of the heart and I-L.
Collapse
Affiliation(s)
- Yanli Yan
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Zhou Lu
- Department of Radiotherapy, Oncology Department, Xi'an Gaoxin Hospital, Xi'an, Shaanxi 710075, P.R. China
| | - Zi Liu
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Wei Luo
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Shuai Shao
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Li Tan
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xiaowei Ma
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jiaxin Liu
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Emmanuel Kwateng Drokow
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Juan Ren
- Department of Radiotherapy, Oncology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| |
Collapse
|
6
|
Wang X, Wang JZ, Li JB, Zhang YJ, Li FX, Wang W, Guo YL, Shao Q, Xu M, Liu XJ, Wang Y. Changes in cardiac volume determined with repeated enhanced 4DCT during chemoradiotherapy for esophageal cancer. Radiat Oncol 2018; 13:181. [PMID: 30227865 PMCID: PMC6145198 DOI: 10.1186/s13014-018-1121-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/30/2018] [Indexed: 12/25/2022] Open
Abstract
Background Concurrent chemoradiotherapy is considered curative intent treatment for patients with non-operative esophageal cancer. Radiation-induced heart damage receives much attention. We performed repeated four-dimensional computed tomography (4DCT) to detect changes in cardiac volume during radiotherapy for esophageal cancer patients, and explored potential factors responsible for those changes. Methods Forty-six patients with esophageal cancer underwent enhanced 4DCT and three-dimensional (3D) CT scans before radiotherapy and every 10 fractions during treatment. The heart was contoured on 3DCT images, 4DCT end expiratory (EE) images and 4DCT maximum intensity projection (MIP) images by the same radiation oncologist. Heart volumes and other relative parameters were compared by the SPSS software package, version 19.0. Results Compared with its initial value, heart volume was smaller at the 10th fraction (reduction = 3.27%, 4.45% and 4.52% on 3DCT, EE and MIP images, respectively, p < 0.05) and the 20th fraction (reduction = 6.05%, 5.64% and 4.51% on 3DCT, EE and MIP images, respectively, p < 0.05), but not at the 30th fraction. Systolic and diastolic blood pressures were reduced (by 16.95 ± 16.69 mmHg and 7.14 ± 11.64 mmHg, respectively, both p < 0.05) and the heart rate was elevated by 5.27 ± 6.25 beats/min (p < 0.05) after radiotherapy. None of the potential explanatory variables correlated with heart volume changes. Conclusions Cardiac volume reduced significantly from an early treatment stage and maintained the reduction until the middle stage. The heart volume changes observed on 3DCT and 4DCT were consistent during radiotherapy. The changes in heart volume, blood pressure and heart rate may be valuable indicators of cardiac impairment and target dose changes.
Collapse
Affiliation(s)
- Xue Wang
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong Province, China.,Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Jin-Zhi Wang
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China.
| | - Jian-Bin Li
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China.
| | - Ying-Jie Zhang
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Feng-Xiang Li
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Wei Wang
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Yan-Luan Guo
- Department of PET-CT Room, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - Qian Shao
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Min Xu
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Xi-Jun Liu
- Department of Thoracic Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Yue Wang
- Medical imaging department, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| |
Collapse
|
7
|
Zhang Y, Liu J, Zhang W, Deng W, Yue J. Treatment of esophageal cancer with radiation therapy -a pan-Chinese survey of radiation oncologists. Oncotarget 2017; 8:34946-34953. [PMID: 28430590 PMCID: PMC5471024 DOI: 10.18632/oncotarget.16858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/28/2017] [Indexed: 01/04/2023] Open
Abstract
Lots of controversies were found about the treatment in relation to radiation therapy (RT) for esophageal squamous cell carcinoma (ESCC). We designed a questionnaire of these controversies to do a pan-Chinese survey of radiation oncologists (ROs). For operable ESCC, 53% ROs chose surgery plus postoperative chemoradiotherapy (CRT), while 40% chose preoperative CRT plus surgery. For target volume of postoperative RT, most ROs (92%) would delineate tumor bed plus involved lymph nodes region before surgery. For definitive RT, most ROs (81%) would give patients higher RT dose to 60-65Gy. For radiation target volume, most ROs would give patients prophylactic irradiation of the bilateral superclavicular-lymph nodes region for cervical ESCC (93%), and the left gastric lymph nodes region for lower thoracic ESCC (72%). For the treatment of mediastinal lymph nodes, 72% ROs preferred elective nodal irradiation, while 28% did the involved nodal irradiation. For concurrent chemotherapy regimen, PF (5-Fu + cisplatin) and TP (cisplatin + paclitaxel) were used widely (49% and 46%, respectively). During simulation, four-dimensional computer tomography (4D CT) was not widely used (48%), even for cervical or lower thoracic ESCC (52%). For daily RT delivery, only 66% ROs would perform imaging guidance RT daily. In summary, more controversies existed in the treatment of ESCC with RT in China, including treatment strategy, radiation dose and target contour. Future goals include standardization of treatment strategy, radiation dose, and target contour, and application of 4D CT and daily imaging guidance, and pursuit of randomized trials in Chinese population.
Collapse
Affiliation(s)
- Yun Zhang
- School of Medicine and Life Sciences, University of Jinan Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jing Liu
- Graduate Education Center, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | | | - Weiye Deng
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health at Houston, Houston, Texas, USA
| | - Jinbo Yue
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
| |
Collapse
|
8
|
Block AM, Patel R, Surucu M, Harkenrider MM, Roeske JC. Evaluation of a template-based algorithm for markerless lung tumour localization on single- and dual-energy kilovoltage images. Br J Radiol 2016; 89:20160648. [PMID: 27730838 PMCID: PMC5604930 DOI: 10.1259/bjr.20160648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate a template-based matching algorithm on single-energy (SE) and dual-energy (DE) radiographs for markerless localization of lung tumours. METHODS A total of 74 images from 17 patients with Stages IA-IV lung cancer were considered. At the time of radiotherapy treatment, gated end-expiration SE radiographs were obtained at 60 and 120 kVp at different gantry angles (33° anterior and 41° oblique), from which soft-tissue-enhanced DE images were created. A template-based matching algorithm was used to localize individual tumours on both SE and DE radiographs. Tumour centroid co-ordinates obtained from the template-matching software on both SE and DE images were compared with co-ordinates defined by physicians. RESULTS The template-based matching algorithm was able to successfully localize the gross tumor volume within 5 mm on 70% (52/74) of the SE images vs 91% (66/74) of the DE images (p < 0.01). The mean vector differences between the co-ordinates of the template matched by the algorithm and the co-ordinates of the physician-defined ground truth were 3.2 ± 2.8 mm for SE images vs 2.3 ± 1.7 mm for DE images (p = 0.03). CONCLUSION Template-based matching on DE images was more accurate and precise than using SE images. Advances in knowledge: This represents, to the authors' knowledge, the largest study evaluating template matching on clinical SE and DE images, considering not only anterior gantry angles but also oblique angles, suggesting a novel lung tumour matching technique using DE subtraction that is reliable, accurate and precise.
Collapse
Affiliation(s)
- Alec M Block
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - Rakesh Patel
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - Murat Surucu
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - John C Roeske
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| |
Collapse
|