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Najem E, Marin T, Zhuo Y, Lahoud RM, Tian F, Beddok A, Rozenblum L, Xing F, Moteabbed M, Lim R, Liu X, Woo J, Lostetter SJ, Lamane A, Chen YLE, Ma C, El Fakhri G. The role of 18F-FDG PET in minimizing variability in gross tumor volume delineation of soft tissue sarcomas. Radiother Oncol 2024; 194:110186. [PMID: 38412906 PMCID: PMC11042980 DOI: 10.1016/j.radonc.2024.110186] [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: 08/18/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Accurate gross tumor volume (GTV) delineation is a critical step in radiation therapy treatment planning. However, it is reader dependent and thus susceptible to intra- and inter-reader variability. GTV delineation of soft tissue sarcoma (STS) often relies on CT and MR images. PURPOSE This study investigates the potential role of 18F-FDG PET in reducing intra- and inter-reader variability thereby improving reproducibility of GTV delineation in STS, without incurring additional costs or radiation exposure. MATERIALS AND METHODS Three readers performed independent GTV delineation of 61 patients with STS using first CT and MR followed by CT, MR, and 18F-FDG PET images. Each reader performed a total of six delineation trials, three trials per imaging modality group. Dice Similarity Coefficient (DSC) score and Hausdorff distance (HD) were used to assess both intra- and inter-reader variability using generated simultaneous truth and performance level estimation (STAPLE) GTVs as ground truth. Statistical analysis was performed using a Wilcoxon signed-ranked test. RESULTS There was a statistically significant decrease in both intra- and inter-reader variability in GTV delineation using CT, MR 18F-FDG PET images vs. CT and MR images. This was translated by an increase in the DSC score and a decrease in the HD for GTVs drawn from CT, MR and 18F-FDG PET images vs. GTVs drawn from CT and MR for all readers and across all three trials. CONCLUSION Incorporation of 18F-FDG PET into CT and MR images decreased intra- and inter-reader variability and subsequently increased reproducibility of GTV delineation in STS.
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Affiliation(s)
- Elie Najem
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Thibault Marin
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Yue Zhuo
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Rita Maria Lahoud
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Fei Tian
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Arnaud Beddok
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Laura Rozenblum
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Fangxu Xing
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Maryam Moteabbed
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA; Radiation Oncology Department, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Ruth Lim
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Xiaofeng Liu
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Jonghye Woo
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Stephen John Lostetter
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Abdallah Lamane
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA
| | - Yen-Lin Evelyn Chen
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 125 Nashua St., 25 Shattuck St., Boston, MA 02114, USA; Radiation Oncology Department, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Chao Ma
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA
| | - Georges El Fakhri
- Yale PET Center, Dept. of Radiology and Biomedical Imaging, Yale University, 801 Howard Avenue, New Haven, CT 06520, USA.
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Barragán‐Montero AM, Van Ooteghem G, Dumont D, Rivas ST, Sterpin E, Geets X. Dosimetrically triggered adaptive radiotherapy for head and neck cancer: Considerations for the implementation of clinical protocols. J Appl Clin Med Phys 2023; 24:e14095. [PMID: 37448193 PMCID: PMC10647964 DOI: 10.1002/acm2.14095] [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: 03/09/2023] [Revised: 05/25/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE Defining dosimetric rules to automatically detect patients requiring adaptive radiotherapy (ART) is not straightforward, and most centres perform ad-hoc ART with no specific protocol. This study aims to propose and analyse different steps to design a protocol for dosimetrically triggered ART of head and neck (H&N) cancer. As a proof-of-concept, the designed protocol was applied to patients treated in TomoTherapy units, using their available software for daily MVCT image and dose accumulation. METHODS An initial protocol was designed by a multidisciplinary team, with a set of flagging criteria based only on dose-volume metrics, including two action levels: (1) surveillance (orange flag), and (2) immediate verification (red flag). This protocol was adapted to the clinical needs following an iterative process. First, the protocol was applied to 38 H&N patients with daily imaging. Automatic software generated the daily contours, recomputed the daily dose and flagged the dosimetric differences with respect to the planning dose. Second, these results were compared, by a sensitivity/specificity test, to the answers of a physician. Third, the physician, supported by the multidisciplinary team, performed a self-analysis of the provided answers and translated them into mathematical rules in order to upgrade the protocol. The upgraded protocol was applied to different definitions of the target volume (i.e. deformed CTV + 0, 2 and 4 mm), in order to quantify how the number of flags decreases when reducing the CTV-to-PTV margin. RESULTS The sensitivity of the initial protocol was very low, specifically for the orange flags. The best values were 0.84 for red and 0.15 for orange flags. After the review and upgrade process, the sensitivity of the upgraded protocol increased to 0.96 for red and 0.84 for orange flags. The number of patients flagged per week with the final (upgraded) protocol decreased in median by 26% and 18% for red and orange flags, respectively, when reducing the CTV-to-PTV margin from 4 to 2 mm. This resulted in only one patient flagged at the last fraction for both red and orange flags. CONCLUSION Our results demonstrate the value of iterative protocol design with retrospective data, and shows the feasibility of automatically-triggered ART using simple dosimetric rules to mimic the physician's decisions. Using a proper target volume definition is important and influences the flagging rate, particularly when decreasing the CTV-to-PTV margin.
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Affiliation(s)
| | - Geneviève Van Ooteghem
- UCLouvainCenter of Molecular ImagingRadiotherapy and Oncology (MIRO)BrusselsBelgium
- Department of Radiation OncologyCliniques universitaires Saint‐LucBrusselsBelgium
| | - Damien Dumont
- UCLouvainCenter of Molecular ImagingRadiotherapy and Oncology (MIRO)BrusselsBelgium
- Department of Radiation OncologyCliniques universitaires Saint‐LucBrusselsBelgium
| | - Sara Teruel Rivas
- UCLouvainCenter of Molecular ImagingRadiotherapy and Oncology (MIRO)BrusselsBelgium
| | - Edmond Sterpin
- UCLouvainCenter of Molecular ImagingRadiotherapy and Oncology (MIRO)BrusselsBelgium
- Department of OncologyLaboratory of Experimental RadiotherapyKU LeuvenLeuvenBelgium
| | - Xavier Geets
- UCLouvainCenter of Molecular ImagingRadiotherapy and Oncology (MIRO)BrusselsBelgium
- Department of Radiation OncologyCliniques universitaires Saint‐LucBrusselsBelgium
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3
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Bang C, Bernard G, Le WT, Lalonde A, Kadoury S, Bahig H. Artificial intelligence to predict outcomes of head and neck radiotherapy. Clin Transl Radiat Oncol 2023; 39:100590. [PMID: 36935854 PMCID: PMC10014342 DOI: 10.1016/j.ctro.2023.100590] [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: 01/13/2023] [Revised: 01/28/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
Head and neck radiotherapy induces important toxicity, and its efficacy and tolerance vary widely across patients. Advancements in radiotherapy delivery techniques, along with the increased quality and frequency of image guidance, offer a unique opportunity to individualize radiotherapy based on imaging biomarkers, with the aim of improving radiation efficacy while reducing its toxicity. Various artificial intelligence models integrating clinical data and radiomics have shown encouraging results for toxicity and cancer control outcomes prediction in head and neck cancer radiotherapy. Clinical implementation of these models could lead to individualized risk-based therapeutic decision making, but the reliability of the current studies is limited. Understanding, validating and expanding these models to larger multi-institutional data sets and testing them in the context of clinical trials is needed to ensure safe clinical implementation. This review summarizes the current state of the art of machine learning models for prediction of head and neck cancer radiotherapy outcomes.
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Key Words
- ADASYN, adaptive synthetic sampling
- AI, artificial intelligence
- ANN, artificial neural network
- AUC, Area Under the ROC Curve
- Artificial intelligence
- BMI, body mass index
- C-Index, concordance index
- CART, Classification and Regression Tree
- CBCT, cone-beam computed tomography
- CIFE, conditional informax feature extraction
- CNN, convolutional neural network
- CRT, chemoradiation
- CT, computed tomography
- Cancer outcomes
- DL, deep learning
- DM, distant metastasis
- DSC, Dice Similarity Coefficient
- DSS, clinical decision support systems
- DT, Decision Tree
- DVH, Dose-volume histogram
- GANs, Generative Adversarial Networks
- GB, Gradient boosting
- GPU, graphical process units
- HNC, head and neck cancer
- HPV, human papillomavirus
- HR, hazard ratio
- Head and neck cancer
- IAMB, incremental association Markov blanket
- IBDM, image based data mining
- IBMs, image biomarkers
- IMRT, intensity-modulated RT
- KNN, k nearest neighbor
- LLR, Local linear forest
- LR, logistic regression
- LRR, loco-regional recurrence
- MIFS, mutual information based feature selection
- ML, machine learning
- MRI, Magnetic resonance imaging
- MRMR, Minimum redundancy feature selection
- Machine learning
- N-MLTR, Neural Multi-Task Logistic Regression
- NPC, nasopharynx
- NTCP, Normal Tissue Complication Probability
- OPC, oropharyngeal cancer
- ORN, osteoradionecrosis
- OS, overall survival
- PCA, Principal component analysis
- PET, Positron emission tomography
- PG, parotid glands
- PLR, Positive likelihood ratio
- PM, pharyngeal mucosa
- PTV, Planning target volumes
- PreSANet, deep preprocessor module and self-attention
- Predictive modeling
- QUANTEC, Quantitative Analyses of Normal Tissue Effects in the Clinic
- RF, random forest
- RFC, random forest classifier
- RFS, recurrence free survival
- RLR, Rigid logistic regression
- RRF, Regularized random forest
- RSF, random survival forest
- RT, radiotherapy
- RTLI, radiation-induced temporal lobe injury
- Radiomic
- SDM, shared decision making
- SMG, submandibular glands
- SMOTE, synthetic minority over-sampling technique
- STIC, sticky saliva
- SVC, support vector classifier
- SVM, support vector machine
- XGBoost, extreme gradient boosting
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Affiliation(s)
- Chulmin Bang
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Corresponding author at: Centre Hospitalier de l'Université de Montréal, 3840 Rue Saint-Urbain, Montréal, QC H2W 1T8, Canada.
| | - Galaad Bernard
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - William T. Le
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Polytechnique Montréal, Montreal, QC, Canada
| | - Arthur Lalonde
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
| | - Samuel Kadoury
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Polytechnique Montréal, Montreal, QC, Canada
| | - Houda Bahig
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
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Yen A, Choi B, Inam E, Yeh A, Lin MH, Park C, Hrycushko B, Nwachukwu C, Albuquerque K. Spare the Bowel, Don't Spoil the Target: Optimal Margin Assessment for Online Cone Beam Adaptive Radiation Therapy (OnC-ART) of the Cervix. Pract Radiat Oncol 2023; 13:e176-e183. [PMID: 36356834 DOI: 10.1016/j.prro.2022.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE The standard treatment for locally advanced cervical cancer involves pelvic chemoradiation. Intensity modulated radiation therapy planning requires expansion of the cervix and uterus clinical target volume (CTV) by 1.5 to 2 cm to account for motion. With online cone beam adaptive radiation therapy (OnC-ART), interfractional movement is accounted for, which can potentially lead to smaller CTV to planned target volume (PTV) margins. In this study, we attempted to determine the optimal CTV-to-PTV margin for adequate coverage with OnC-ART and factors that can affect CTV coverage. METHODS AND MATERIALS A retrospective cohort of 21 patients with cervical cancer treated with definitive chemoradiation was included. Nine patients treated with nonadaptive radiation had the uterocervix contoured on pretreatment cone beam computed tomography (CBCT) and end-treatment CBCTs. Anterior-posterior, lateral, and superior-inferior shifts and the average shift in all directions were calculated. A CTV-to-PTV expansion was determined and verified on a validation cohort of 12 patients treated with OnC-ART. RESULTS The average anterior-posterior, lateral, and superior-inferior shifts with standard deviation were 0.32 ± 1.55 cm, 0.12 ± 2.31 cm, and 1.67 ± 3.41 cm, respectively. A uniform 5-mm expansion around the pretreatment CTV covered 98.85% ± 1.23% of the end-treatment CTV. This 5-mm expansion was applied to our validation cohort treated with OnC-ART, and 98.39% ± 3.0% of the end-treatment CTV was covered. Time between CBCTs >30 minutes and change in bladder volume were significantly correlated to CTV coverage. CONCLUSIONS Based on our analysis, a CTV-to-PTV margin of 5 mm is adequate to encompass 98% of the CTV. A significantly reduced margin could potentially decrease the toxicities associated with radiation for patients with cervical cancer and lead to improved patient reported toxicity outcomes. We recommend physicians begin with a 5-mm margin and assess adequate coverage with image guidance during daily adaptation.
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Affiliation(s)
- Allen Yen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Byongsu Choi
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Enobang Inam
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Austin Yeh
- College of Natural Science, University of Texas at Austin, Austin, Texas
| | - Mu-Han Lin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chunjoo Park
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Brian Hrycushko
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chika Nwachukwu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Evaluation of the accuracy of a six-degree-of-freedom robotic couch using optical surface and cone beam CT images of an SRS QA phantom. JOURNAL OF RADIOTHERAPY IN PRACTICE 2023. [DOI: 10.1017/s1460396922000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract
Purpose:
To assess the accuracy of the Varian PerfectPitch six-degree-of-freedom (6DOF) robotic couch by using a Varian SRS QA phantom.
Methods:
The stereotactic radiosurgery (SRS) phantom has five tungsten carbide BBs each with 7·5 mm in diameter arranged with the known geometry. Optical surface images and cone beam CT (CBCT) images of the phantom were taken at different pitch, roll and rotation angles. The pitch, roll, and rotation angles were varied from −3 to 3 degrees by inputs from the linac console. A total of 39 Vision RT images with different rotation angle combinations were collected, and the Vision RT software was used to determine the rotation angles and translational shifts from those images. Eight CBCT images at most allowed rotational angles were analysed by in-house software. The software took the coordinates of the voxel of the maximum CT number inside a 7·5-mm sphere surrounding one BB to be the measured position of this BB. Expected BB positions at different rotation angles were determined by multiplying measured BB positions at zero pitch and roll values by a rotation matrix. Applying the rotation matrix to 5 BB positions yielded 15 equations. A linear least square method was used for regression analysis to approximate the solutions of those equations.
Results:
Of the eight calculations from CBCT images, the maximum rotation angle differences (degree) were 0·10 for pitch, 0·15 for roll and 0·09 for yaw. The maximum translation differences were 0·3 mm in the left–right direction, 0·5 mm in the anterior–posterior direction and 0·4 mm in the superior–inferior direction.
Conclusions:
The uncertainties of the 6-DOF couch were examined with the methods of optical surface imaging and CBCT imaging of the SRS QA phantom. The rotational errors were less than 0·2 degree, and the isocentre shifts were less than 0·8 mm.
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Parchur AK, Lim S, Nasief H, Omari E, Zhang Y, Paulson E, Hall W, Erickson B, Li XA. Auto-detection of necessity for MRI-guided online adaptive replanning using a machine learning classifier. Med Phys 2023; 50:440-448. [PMID: 36227732 PMCID: PMC9868055 DOI: 10.1002/mp.16047] [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: 03/24/2022] [Revised: 09/23/2022] [Accepted: 10/08/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE MRI-guided adaptive radiation therapy (MRgART), particularly daily online adaptive replanning (OLAR) can substantially improve radiation therapy delivery, however, it can be labor-intensive and time-consuming. Currently, the decision to perform OLAR for a treatment fraction is determined subjectively. In this work, we develop a machine learning algorithm based on structural similarity index measure (SSIM) and change in entropy to quickly and objectively determine whether OLAR is necessary for a daily MRI set. METHODS A total of 109 daily MRI sets acquired on a 1.5T MR-Linac during MRgART for 22 pancreatic cancer patients each treated with five fractions were retrospectively analyzed. For each daily MRI set, OLAR and reposition (No-OLAR) plans were created and the superior plan with the daily fraction determined per clinical dose-volume criteria. SSIM and entropy maps were extracted from each daily MRI set, with respect to its reference (e.g., dry-run) MRI in the region enclosed by 50-100% isodose surfaces. A total of six common features were extracted from SSIM maps. Pearson's rank correlation coefficient was utilized to rule out redundant SSIM features. A t-test was used to determine significant SSIM features which were combined with the change in entropy to develop anensemble machine classifier with fivefold cross validation. The performance of the classifier was evaluated using the area under the curve (AUC) of the receiver operating characteristic curve. RESULTS A machine learning classifier model using two SSIM features (mean and full width at half maximum) and change in entropy was determined to be able to significantly discriminate between No-OLAR and OLAR groups. The obtained machine learning ensemble classifier can predict OLAR necessity with a cross validated AUC of 0.93. Misclassification was found primarily for No-OLAR cases with dosimetric plan quality closely comparable to the corresponding OLAR plans, thus, are not a major practical concern. CONCLUSION A machine learning classifier based on simple first-order image features, that is, SSIM features and change in entropy, was developed to determine when OLAR is necessary for a daily MRI set with practical acceptable prediction accuracy. This classifier may be implemented in the MRgART process to automatically and objectively determine if OLAR is required following daily MRI.
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Affiliation(s)
- Abdul K. Parchur
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - Sara Lim
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - Haidy Nasief
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - Eenas Omari
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - Ying Zhang
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - Eric Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - William Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - X. Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
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7
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Vaz SC, Adam JA, Bolton RCD, Vera P, van Elmpt W, Herrmann K, Hicks RJ, Lievens Y, Santos A, Schöder H, Dubray B, Visvikis D, Troost EGC, de Geus-Oei LF. Joint EANM/SNMMI/ESTRO practice recommendations for the use of 2-[ 18F]FDG PET/CT external beam radiation treatment planning in lung cancer V1.0. Eur J Nucl Med Mol Imaging 2022; 49:1386-1406. [PMID: 35022844 PMCID: PMC8921015 DOI: 10.1007/s00259-021-05624-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022]
Abstract
Purpose 2-[18F]FDG
PET/CT is of utmost importance for radiation treatment (RT) planning and response monitoring in lung cancer patients, in both non-small and small cell lung cancer (NSCLC and SCLC). This topic has been addressed in guidelines composed by experts within the field of radiation oncology. However, up to present, there is no procedural guideline on this subject, with involvement of the nuclear medicine societies. Methods A literature review was performed, followed by a discussion between a multidisciplinary team of experts in the different fields involved in the RT planning of lung cancer, in order to guide clinical management. The project was led by experts of the two nuclear medicine societies (EANM and SNMMI) and radiation oncology (ESTRO). Results and conclusion This guideline results from a joint and dynamic collaboration between the relevant disciplines for this topic. It provides a worldwide, state of the art, and multidisciplinary guide to 2-[18F]FDG PET/CT RT planning in NSCLC and SCLC. These practical recommendations describe applicable updates for existing clinical practices, highlight potential flaws, and provide solutions to overcome these as well. Finally, the recent developments considered for future application are also reviewed.
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Affiliation(s)
- Sofia C Vaz
- Nuclear Medicine Radiopharmacology, Champalimaud Centre for the Unkown, Champalimaud Foundation, Lisbon, Portugal.,Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Judit A Adam
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño (La Rioja), Spain
| | - Pierre Vera
- Henri Becquerel Cancer Center, QuantIF-LITIS EA 4108, Université de Rouen, Rouen, France
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.
| | - Rodney J Hicks
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Andrea Santos
- Nuclear Medicine Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Bernard Dubray
- Department of Radiotherapy and Medical Physics, Centre Henri Becquerel, Rouen, France.,QuantIF-LITIS EA4108, University of Rouen, Rouen, France
| | | | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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8
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Alves N, Dias JM, Rocha H, Ventura T, Mateus J, Capela M, Khouri L, Lopes MDC. Assessing the need for adaptive radiotherapy in head and neck cancer patients using an automatic planning tool. Rep Pract Oncol Radiother 2021; 26:423-432. [PMID: 34277096 PMCID: PMC8281904 DOI: 10.5603/rpor.a2021.0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background Unbiased analysis of the impact of adaptive radiotherapy (ART) is necessary to evaluate dosimetric benefit and optimize clinics' workflows. The aim of the study was to assess the need for adaptive radiotherapy (ART) in head and neck (H&N) cancer patients using an automatic planning tool in a retrospective planning study. Materials and methods Thirty H&N patients treated with adaptive radiotherapy were analysed. Patients had a CT scan for treatment planning and a verification CT during treatment according to the clinic's protocol. Considering these images, three plans were retrospectively generated using the iCycle tool to simulate the scenarios with and without adaptation: 1) the optimized plan based on the planning CT; 2) the optimized plan based on the verification CT (ART-plan); 3) the plan obtained by considering treatment plan 1 re-calculated in the verification CT (non-ART plan). The dosimetric endpoints for both target volumes and OAR were compared between scenarios 2 and 3 and the SPIDERplan used to evaluate plan quality. Results The most significant impact of ART was found for the PTVs, which demonstrated decreased D98% in the non-ART plan. A general increase in the dose was observed for the OAR but only the spinal cord showed a statistical significance. The SPIDERplan analysis indicated an overall loss of plan quality in the absence of ART. Conclusion These results confirm the advantages of ART in H&N patients, especially for the coverage of target volumes. The usage of an automatic planning tool reduces planner-induced bias in the results, guaranteeing that the observed changes derive from the application of ART.
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Affiliation(s)
- Natália Alves
- Physics Department, Faculty of Science and Technology, University of Coimbra, Coimbra, Portugal
| | - Joana Matos Dias
- Instituto de Engenharia de Sistemas e Computadores de Coimbra, Coimbra, Portugal.,Faculty of Economics, University of Coimbra, Coimbra, Portugal
| | - Humberto Rocha
- Instituto de Engenharia de Sistemas e Computadores de Coimbra, Coimbra, Portugal.,Faculty of Economics, University of Coimbra, Coimbra, Portugal
| | - Tiago Ventura
- Instituto de Engenharia de Sistemas e Computadores de Coimbra, Coimbra, Portugal.,Medical Physics Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
| | - Josefina Mateus
- Medical Physics Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
| | - Miguel Capela
- Medical Physics Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
| | - Leila Khouri
- Radiotherapy Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
| | - Maria do Carmo Lopes
- Instituto de Engenharia de Sistemas e Computadores de Coimbra, Coimbra, Portugal.,Medical Physics Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
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Mee T, Vickers AJ, Jena R, Kirkby KJ, Choudhury A, Kirkby NF. Variations in Demand across England for the Magnetic Resonance-Linac Technology, Simulated Utilising Local-level Demographic and Cancer Data in the Malthus Project. Clin Oncol (R Coll Radiol) 2021; 33:e285-e294. [PMID: 33775495 PMCID: PMC8217906 DOI: 10.1016/j.clon.2021.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/14/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
AIMS Cancer incidence varies across England, which affects the local-level demand for treatments. The magnetic resonance-linac (MR-linac) is a new radiotherapy technology that combines imaging and treatment. Here we model the demand and demand variations for the MR-linac across England. MATERIALS AND METHODS Initial clinical indications were provided by the MR-linac consortium and introduced into the Malthus radiotherapy clinical decision trees. The Malthus model contains Clinical Commissioning Group (CCG) population, cancer incidence and stage presentation data (for lung and prostate) and simulated the demand for the MR-linac for all CCGs and Radiotherapy Operational Delivery Networks (RODN) across England. RESULTS Based on the initial target clinical indications, the MR-linac could service 16% of England's fraction burden. The simulated fractions/million population demand/annum varies between 3000 and 10 600 fractions/million at the CCG level. Focussing only on the cancer population, the simulated fractions/1000 cancer cases demand/annum ranges from 1028 to 1195 fractions/1000 cases. If a national average for fractions/million demand was then used, at the RODN level, the variation from actual annual demand ranges from an overestimation of 8400 fractions to an underestimation of 5800 fractions. When using the national average fractions/1000 cases, the RODN demand varies from an overestimation of 3200 fractions to an underestimation of 3000 fractions. CONCLUSIONS Planning cancer services is complex due to regional variations in cancer burden. The variations in simulated demand of the MR-linac highlight the requirement to use local-level data when planning to introduce a new technology.
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Affiliation(s)
- T Mee
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - A J Vickers
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - R Jena
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - K J Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - A Choudhury
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - N F Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Boeke S, Mönnich D, van Timmeren JE, Balermpas P. MR-Guided Radiotherapy for Head and Neck Cancer: Current Developments, Perspectives, and Challenges. Front Oncol 2021; 11:616156. [PMID: 33816247 PMCID: PMC8017313 DOI: 10.3389/fonc.2021.616156] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
Based on the development of new hybrid machines consisting of an MRI and a linear accelerator, magnetic resonance image guided radiotherapy (MRgRT) has revolutionized the field of adaptive treatment in recent years. Although an increasing number of studies have been published, investigating technical and clinical aspects of this technique for various indications, utilizations of MRgRT for adaptive treatment of head and neck cancer (HNC) remains in its infancy. Yet, the possible benefits of this novel technology for HNC patients, allowing for better soft-tissue delineation, intra- and interfractional treatment monitoring and more frequent plan adaptations appear more than obvious. At the same time, new technical, clinical, and logistic challenges emerge. The purpose of this article is to summarize and discuss the rationale, recent developments, and future perspectives of this promising radiotherapy modality for treating HNC.
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Affiliation(s)
- Simon Boeke
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - David Mönnich
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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11
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Thomas M, De Roover R, van der Merwe S, Lambrecht M, Defraene G, Haustermans K. The use of tumour markers in oesophageal cancer to quantify setup errors and baseline shifts during treatment. Clin Transl Radiat Oncol 2020; 26:8-14. [PMID: 33251342 PMCID: PMC7677672 DOI: 10.1016/j.ctro.2020.11.001] [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: 07/15/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 12/24/2022] Open
Abstract
Implantation of solid gold markers safe. Inter-fractional motion for markers in distal oesophagus largest cranio-caudally. Reduced radiotherapy treatment margins with soft-tissue vs. bony-anatomy matching. Impact of intra-fractional baseline shifts on margin calculation rather small.
Purpose To prospectively evaluate the feasibility of solid gold marker placement in oesophageal cancer patients and to quantify inter-fractional and intra-fractional (baseline shift) marker motion during radiation treatment. Radiotherapy target margins and matching strategies were investigated. Materials/methods Thirty-four markers were implanted by echo-endoscopy in 10 patients. Patients received a planning 4D CT, daily pre-treatment cone-beam CT (CBCT) and a post-treatment CBCT for at least five fractions. For fractions with both pre- and post-treatment CBCT, marker displacement between planning CT and pre-treatment CBCT (inter-fractional) and between pre-treatment and post-treatment CBCT (intra-fractional; only for fractions without rotational treatment couch correction) were calculated in left–right (LR), cranio-caudal (CC) and anterior-posterior (AP) direction after bony-anatomy and soft-tissue matching. Systematic/random setup errors were estimated; treatment margins were calculated. Results No serious adverse events occurred. Twenty-three (67.6%) markers were visible during radiotherapy (n = 3 middle oesophagus, n = 16 distal oesophagus, n = 4 proximal stomach). Margins for inter-fractional displacement after bony-anatomy match depended on the localisation of the primary tumour and were 11.2 mm (LR), 16.4 mm (CC) and 8.2 mm (AP) for distal markers. Soft-tissue matching reduced the CC margin for these markers (16.4 mm to 10.5 mm). The mean intra-fractional shift of 12 distal markers was 0.4 mm (LR), 2.3 mm (CC) and 0.7 mm (AP). Inclusion of this shift resulted in treatment margins for distal markers of 12.8 mm (LR), 17.3 mm (CC) and 10.4 mm (AP) after bony-anatomy matching and 12.4 mm (LR), 11.4 mm (CC) and 9.7 mm (AP) after soft-tissue matching. Conclusion This study demonstrated that the implantation of gold markers was safe, albeit less stable compared to other marker types. Inter-fractional motion was largest cranio-caudally for markers in the distal oesophagus, which was reduced after soft-tissue compared to bony-anatomy matching. The impact of intra-fractional baseline shifts on margin calculation was rather small.
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Key Words
- 2D, two-dimensional
- 3D, three-dimensional
- 4D, four-dimensional
- AP, anterior-posterior
- CBCT, cone-beam computed tomography
- CC, cranio-caudal
- CT, computed tomography
- CTV, clinical target volume
- CTVtotal, total clinical target volume
- DoF, degree-of-freedom
- EUS, endoscopic ultrasound
- Esophageal cancer
- FDG-PET/CT, fluorodeoxyglucose positron emission tomography with integrated computed tomography
- Fiducial gold markers
- GM, grand mean
- GTV, gross tumour volume
- IMRT, intensity modulated radiation therapy
- Inter-fractional motion
- Intra-fractional baseline shifts
- LR, left-right
- MRI, magnetic resonance imaging
- Matching strategies
- OAR, organ at risk
- PTV, planning target volume
- Radiotherapy treatment margins
- iCTV, internal clinical target volume
- kV, kilovoltage
- nCRT, neoadjuvant chemoradiation
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Affiliation(s)
- Melissa Thomas
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium.,University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Robin De Roover
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium.,University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Schalk van der Merwe
- University Hospitals Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
| | - Maarten Lambrecht
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium.,University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Gilles Defraene
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | - Karin Haustermans
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium.,University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
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Wang H, Xue J, Chen T, Qu T, Barbee D, Tam M, Hu K. Adaptive radiotherapy based on statistical process control for oropharyngeal cancer. J Appl Clin Med Phys 2020; 21:171-177. [PMID: 32770651 PMCID: PMC7497930 DOI: 10.1002/acm2.12993] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/04/2020] [Accepted: 07/12/2020] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The purpose of this study is to quantify dosimetric changes throughout the delivery of oropharyngeal cancer treatment and to investigate the application of statistical process control (SPC) for the management of significant deviations during the course of radiotherapy. METHODS Thirteen oropharyngeal cancer patients with daily cone beam computed tomography (CBCT) were retrospectively reviewed. Cone beam computed tomography images of every other fraction were imported to the Velocity software and registered to planning CT using the 6 DOF (degrees of freedom) couch shifts generated during patient setup. Using Velocity "Adaptive Monitoring" module, the setup-corrected CBCT was matched to planning CT using a deformable registration. Volumes and dose metrics at each fraction were calculated and rated with plan values to evaluate interfractional dosimetric variations using a SPC framework. T-tests between plan and fraction volumes were performed to find statistically insignificant fractions. Average upper and lower process capacity limits (UCL, LCL) of each dose metric were derived from these fractions using conventional SPC guidelines. RESULTS Gross tumor volume (GTV) and organ at risk (OAR) volumes in the first 13 fractions had no significant changes from the pretreatment planning CT. The GTV and the parotid glands subsequently decreased by 10% at the completion of treatment. There were 3-4% increases in parotid mean doses, but no significant differences in dose metrics of GTV and other OARs. The changes were organ and patient dependent. Control charts for various dose metrics were generated to assess the metrics at each fraction for individual patient. CONCLUSIONS Daily CBCT could be used to monitor dosimetric variations of targets and OARs resulting from volume changes and tissue deformation in oropharyngeal cancer radiotherapy. Treatment review with the guidance of a SPC tool allows for an objective and consistent clinical decision to apply adaptive radiotherapy.
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Affiliation(s)
- Hesheng Wang
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA
| | - Jinyu Xue
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA
| | - Ting Chen
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA
| | - Tanxia Qu
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA
| | - David Barbee
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA
| | - Moses Tam
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA
| | - Kenneth Hu
- Department of Radiation Oncology, NYU Langone Health, New York, NY, USA
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13
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Schröder L, Stankovic U, Sonke J. Technical Note: Long‐term stability of Hounsfield unit calibration for cone beam computed tomography. Med Phys 2020; 47:1640-1644. [DOI: 10.1002/mp.14015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
- Lukas Schröder
- Department of Radiation Oncology The Netherlands Cancer Institute Amsterdam 1066CXThe Netherlands
| | - Uros Stankovic
- Department of Radiation Oncology The Netherlands Cancer Institute Amsterdam 1066CXThe Netherlands
| | - Jan‐Jakob Sonke
- Department of Radiation Oncology The Netherlands Cancer Institute Amsterdam 1066CXThe Netherlands
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Effect of Changing Phantom Thickness on Helical Radiotherapy Plan: Dosimetric Analysis. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2019. [DOI: 10.2478/pjmpe-2019-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Purpose: The aim of this study is to investigate the effect of changing phantom thickness on high dose region of interest (HD_ROI) and low dose ROI’s (LW_ROI’s) doses during helical radiotherapy (RT) by utilizing Adaptive RT (ART) technique.
Materials and Methods: The cylindrical phantom (CP) is wrapped with different thickness boluses and scanned in the kilovoltage computed tomography (KVCT). HD_ROI and LW_ROI’s were created in contouring system and nine same plans (1.8 Gy/Fr) were made with images of different thicknesses CP. The point dose measurements were performed using ionization chamber in Helical Tomotherapy (HT) treatment machine. For detecting thickness reduction effect, CP was irradiated using bolus-designed plans and it was irradiated using without bolus plan. The opposite of this scenario was applied to determine the thickness increase. KVCT and megavoltage CT (MVCT) images were used for dose comparison. The HT Planned Adaptive Software was used to see the differences in the planning and verification doses at dose volume histograms (DVH).
Results: Point dose measurements showed a 4.480% dose increase in 0.5 cm depth reduction for HD_ROI. These differences reached 8.508% in 2 cm depth and 15,279% in 5 cm depth. At the same time, a dose reduction of 0.665% was determined for a 0.5cm depth increase, a dose reduction of 1.771% was determined for a 2 cm depth increase, a dose reduction of 5.202% was determined for a 5 cm depth increase for the HD_ROI. The ART plan results show that the dose changes in the HD_ROI was greater than the LW_ROI’s.
Conclusion: Phantom thicknesses change can lead to a serious dose increase or decrease in the HD_ROI and LW_ROI’s.
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15
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Karaca S, Kırlı M. Adaptive radiation therapy for cervical esophageal cancer: dosimetric and volumetric analysis. J Gastrointest Oncol 2019; 10:506-512. [PMID: 31183201 DOI: 10.21037/jgo.2019.02.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Cervical esophageal cancer (CEC) patients may suffer from significant anatomical changes due to tumor shrinkage or weight loss during radiotherapy. The aim of the study is to evaluate the volumetric and dosimetric changes in the target and critical volumes of CEC patients by using adaptive radiotherapy (ART) technique. Methods Seven CEC patients treated in helical tomotherapy (HT) unit was analyzed. All patients had a replanning CT simulation at 3rd (CT2) and 5th (CT3) weeks in addition to the initial CT (CT1). Volumetric and dosimetric changes of target and organs at risk (OAR) were evaluated. Results The average weight loss of the patients was 9.03%. The major changes of the planning target volume (PTV), PTV boost, right and left parotid volumes were 4.74%; 15.93%; 26.82% and 26.64%, respectively. Using ART software was evaluated with first planning values (CT1) and pre-CT2-CT3 verification values. The correlation was decrease of the D95 and increase of the Dmax was statistically significant. When evaluated the varying values of the new CTs, there was no significant change between the initial PTV and adapted PTV's. But a significant decrease was observed at the summation plan for left and right parotids (P<0.05). The mean dose reductions of left and right parotid were 2.48 and 2.49 Gy, respectively. Conclusions Our results showed that using ART technique was beneficial to ensure adequate doses to the target volumes and safe doses to the OARs for the patients who need replanning during RT in uncommon CEC patients.
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Affiliation(s)
- Sibel Karaca
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Meltem Kırlı
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
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16
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Head and Neck Cancer Adaptive Radiation Therapy (ART): Conceptual Considerations for the Informed Clinician. Semin Radiat Oncol 2019; 29:258-273. [PMID: 31027643 DOI: 10.1016/j.semradonc.2019.02.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
For nearly 2 decades, adaptive radiation therapy (ART) has been proposed as a method to account for changes in head and neck tumor and normal tissue to enhance therapeutic ratios. While technical advances in imaging, planning and delivery have allowed greater capacity for ART delivery, and a series of dosimetric explorations have consistently shown capacity for improvement, there remains a paucity of clinical trials demonstrating the utility of ART. Furthermore, while ad hoc implementation of head and neck ART is reported, systematic full-scale head and neck ART remains an as yet unreached reality. To some degree, this lack of scalability may be related to not only the complexity of ART, but also variability in the nomenclature and descriptions of what is encompassed by ART. Consequently, we present an overview of the history, current status, and recommendations for the future of ART, with an eye toward improving the clarity and description of head and neck ART for interested clinicians, noting practical considerations for implementation of an ART program or clinical trial. Process level considerations for ART are noted, reminding the reader that, paraphrasing the writer Elbert Hubbard, "Art is not a thing, it is a way."
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Bridges D, Kawamura H, Kanai T. Probabilistic dose distribution from interfractional motion in carbon ion radiation therapy for prostate cancer shows rectum sparing with moderate target coverage degradation. PLoS One 2018; 13:e0203289. [PMID: 30169520 PMCID: PMC6118389 DOI: 10.1371/journal.pone.0203289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/18/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE This observational study investigates the influence of interfractional motion on clinical target volume (CTV) coverage, planning target volume (PTV) margins, and rectum tissue sparing in carbon ion radiation therapy (CIRT). It reports dose coverage to target structures and organs at risk in the presence of interfractional motion, investigates rectal tissue sparing, and provides recommendations for lowering the rate of toxicity. We also propose probabilistic DVH based on cone-beam computed tomography (CBCT) table shifts from photon therapy for consideration in bone-matching CIRT treatment planning to represent probable dose to our CIRT patient population. METHODS At Gunma University Hospital intensity-modulated x-ray therapy (IMXT, aka IMRT) prostate cancer patients are positioned on a table which is shifted twice based on CBCT to align bones and then align prostate tissue to isocenter. These shifts thereby contain interfractional motion. A total of 1306 such table shifts from 85 patients were collected. Normal probability distributions were fit to the difference between bone-matching and prostate-matching CBCT-to-planning CT table shifts (i.e. interfractional motion). Between 2011 and 2016 CIRT prostate patients were treated with three beams to PTV1 (lateral-opposing and anterior) one per day for 9 fractions and two beams for a boost PTV2 (lateral-opposing) one per day for 7 fractions for a prescribed total of 57.6 Gy(RBE) as follows: PTV1 extends the prostate contour by 10/10, 5/10, 6/6 mm in the right/left, posterior/anterior, and superior/inferior directions, respectively, and the proximal seminal vesicles contour by 5 mm superiorly and inferiorly, 3 mm right and left. PTV2 reduces PTV1 posteriorly along a straight line to exclude the rectum and reduces the superior and inferior margins by 6 mm. Probable interfractional motion for 40 patients was simulated using each patient's own beam data as follows: The previously fit normal probability distributions were randomly sampled 2000 times per patient, and the five beams were shifted and summed with the same relative weighting as in the 16-fraction regimen. The resulting dose distribution was then scaled back down by 16/2000 to match the prescribed number of fractions. We then analyzed the resulting doses to contoured structures. RESULTS Probable dose to rectum is substantially less than planned: For example, mean+-standard deviation D2% for planned and probable DVH is 51+-1.9 and 45+-2.4, respectively. Cumulative DVH show mean CTV fraction receiving a given probable dose is less than the mean fraction receiving the corresponding planned dose for doses larger than 52 Gy(RBE), up to 19% less at 57.4 Gy(RBE). Our PTV1 margins generally cover 95% of interfractional motion but seminal vesicles and inferior prostate receive less dose than planned due to insufficient PTV2 margins. CONCLUSION Assuming rigidly shifting interfractional motion around the prostate region and neglecting minor changes in soft tissue stopping power, interfractional motion resulted in target underdosing but better tissue sparing in all cases. Given our low rates of relapse and recurrence, it appears less curative dose is needed than previously thought or else current planning target margins may be excessive: Planning target volumes should be reconsidered with the adoption of dose verification methods. Our probable dose distributions quantify expected dose for future dose verification studies.
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Affiliation(s)
- Daniel Bridges
- Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hidemasa Kawamura
- Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Tatsuaki Kanai
- Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
- Osaka Heavy Ion Therapy Center, Osaka, Osaka, Japan
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Tsai YL, Wu CJ, Shaw S, Yu PC, Nien HH, Lui LT. Quantitative analysis of respiration-induced motion of each liver segment with helical computed tomography and 4-dimensional computed tomography. Radiat Oncol 2018; 13:59. [PMID: 29609631 PMCID: PMC5879734 DOI: 10.1186/s13014-018-1007-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/22/2018] [Indexed: 12/16/2022] Open
Abstract
Background To analyze the respiratory-induced motion of each liver segment using helical computed tomography (helical CT) and 4-dimensional computed tomography (4DCT), and to establish the individual segment expansion margin of internal target volume (ITV) to facilitate target delineation of tumors in different liver segments. Methods Twenty patients who received radiotherapy with CT-simulation scanning of the whole liver in both helical CT and 10-phase-gated 4DCT were investigated, including 2 patients with esophagus cancer, 4 with lung cancer, 10 with breast cancer, 2 with liver cancer, 1 with thymoma, and 1 with gastric diffuse large B-cell lymphoma (DLBCL). For each patient, 9 representative points were drawn on the helical CT images of liver segments 1, 2, 3, 4a, 4b, 5, 6, 7, and 8, respectively, and adaptively deformed to 2 phases of the 4DCT images at the end of inspiration (phase 0 CT) and expiration (phase 50 CT) in the treatment planning system. Using the amplitude of each point between phase 0 CT and phase 50 CT, we established quantitative data for the respiration-induced motion of each liver segment in 3-dimensional directions. Moreover, using the amplitude between the original helical CT and both 4DCT images, we rendered the individual segment expansion margin of ITV for hepatic target delineation to cover more than 95% of each tumor. Results The average amplitude (mean ± standard deviation) was 0.6 ± 3.0 mm in the left-right (LR) direction, 2.3 ± 2.4 mm in the anterior-posterior (AP) direction, and 5.7 ± 3.4 mm in the superior-inferior (SI) direction, respectively. All of the segments moved posteriorly and superiorly during expiration. Segment 7 had the largest amplitude in the SI direction, at 8.6 ± 3.4 mm. Otherwise, the segments over the lateral side, including segments 2, 3, 6, and 7, had greater excursion in the SI direction compared to the medial segments. To cover more than 95% of each tumor, the required expansion margin of ITV in the LR, AP, and SI directions were at least 2.5 mm, 2.5 mm, and 5.0 mm on average, respectively, with variations between different segments. Conclusions The greatest excursion occurred in liver segment 7, followed by the segments over the lateral side in the SI direction. The individual segment expansion margin of ITV is required to delineate targets for each segment and direction.
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Affiliation(s)
- Yu-Lun Tsai
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan
| | - Ching-Jung Wu
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan.,Department of Radiation Oncology, National Defense Medical Center, Taipei, Taiwan.,Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Suzun Shaw
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan
| | - Pei-Chieh Yu
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan
| | - Hsin-Hua Nien
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan
| | - Louis Tak Lui
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan.
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20
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MacManus M, Everitt S, Schimek-Jasch T, Li XA, Nestle U, Kong FMS. Anatomic, functional and molecular imaging in lung cancer precision radiation therapy: treatment response assessment and radiation therapy personalization. Transl Lung Cancer Res 2017; 6:670-688. [PMID: 29218270 DOI: 10.21037/tlcr.2017.09.05] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This article reviews key imaging modalities for lung cancer patients treated with radiation therapy (RT) and considers their actual or potential contributions to critical decision-making. An international group of researchers with expertise in imaging in lung cancer patients treated with RT considered the relevant literature on modalities, including computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). These perspectives were coordinated to summarize the current status of imaging in lung cancer and flag developments with future implications. Although there are no useful randomized trials of different imaging modalities in lung cancer, multiple prospective studies indicate that management decisions are frequently impacted by the use of complementary imaging modalities, leading both to more appropriate treatments and better outcomes. This is especially true of 18F-fluoro-deoxyglucose (FDG)-PET/CT which is widely accepted to be the standard imaging modality for staging of lung cancer patients, for selection for potentially curative RT and for treatment planning. PET is also more accurate than CT for predicting survival after RT. PET imaging during RT is also correlated with survival and makes response-adapted therapies possible. PET tracers other than FDG have potential for imaging important biological process in tumors, including hypoxia and proliferation. MRI has superior accuracy in soft tissue imaging and the MRI Linac is a rapidly developing technology with great potential for online monitoring and modification of treatment. The role of imaging in RT-treated lung cancer patients is evolving rapidly and will allow increasing personalization of therapy according to the biology of both the tumor and dose limiting normal tissues.
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Affiliation(s)
- Michael MacManus
- Department of Radiation Oncology, Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Sarah Everitt
- Department of Radiation Oncology, Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Tanja Schimek-Jasch
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, WI, USA
| | - Ursula Nestle
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - Feng-Ming Spring Kong
- Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
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Mathieu D, Campeau MP, Bedwani S, Roberge D, Doucet R, Zerouali K, Bahig H, Vu T, Lambert L, Masucci L, Filion E. The impacts of mid-treatment CBCT-guided patient repositioning on target coverage during lung VMAT. J Med Imaging Radiat Oncol 2017; 61:543-549. [DOI: 10.1111/1754-9485.12591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 12/26/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Dominique Mathieu
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Marie-Pierre Campeau
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Stéphane Bedwani
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - David Roberge
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Robert Doucet
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Karim Zerouali
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Houda Bahig
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Toni Vu
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Louise Lambert
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Laura Masucci
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
| | - Edith Filion
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal; Montreal Quebec Canada
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Zhang Q, Driewer J, Wang S, Li S, Zhu X, Zheng D, Cao Y, Zhang J, Jamshidi A, Cox BW, Knisely JPS, Potters L, Klein EE. Accuracy evaluation of a six-degree-of-freedom couch using cone beam CT and IsoCal phantom with an in-house algorithm. Med Phys 2017; 44:3888-3898. [PMID: 28500790 DOI: 10.1002/mp.12342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/24/2017] [Accepted: 05/03/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The accuracy of a six degree of freedom (6DoF) couch was evaluated using a novel method. METHODS Cone beam CT (CBCT) images of a 3D phantom (IsoCal) were acquired with different, known combinations of couch pitch and roll angles. Pitch and roll angles between the maximum allowable values of 357 and 3 degrees were tested in one degree increments. A total of 49 combinations were tested at 0 degrees of yaw (couch rotation angle). The 3D positions of 16 tungsten carbide ball bearings (BBs), each 4 mm in diameter and arranged in a known geometry within the IsoCal phantom, were determined in the 49 image sets with in-house software. The BB positions at different rotation angles were determined using a rotation matrix from the original BB positions at zero pitch and roll angles. A linear least squares fit method estimated the rotation angles and differences between detected and nominal rotation angles were calculated. This study was conducted for the case with and without extra weight on the couch. Couch walk shifts for the system were investigated using eight combinations of rotation, roll and pitch. RESULTS A total of 49 CBCT images with voxel sizes 0.5 × 0.5 × 1.0 mm3 were taken for the case without extra weight on the couch. The 16 BBs were determined to evaluate the isocenter translation and rotation differences between the calculated and nominal couch values. Among all 49 calculations, the maximum rotation angle differences were 0.10 degrees for pitch, 0.15 degrees for roll and 0.09 degrees for yaw. The corresponding mean and standard deviation values were 0.028 ± 0.032, -0.043 ± 0.058, and -0.009 ± 0.033 degrees. The maximum translation differences were 0.3 mm in the left-right direction, 0.5 mm in the anterior-posterior direction and 0.4 mm in the superior-inferior direction. The mean values and corresponding standard deviations were 0.07 ± 0.12, -0.05 ± 0.25, and -0.12±0.14 mm for the planes described above. With an 80 kg phantom on the couch, the maximum translation shift was 0.69 mm. The couch walk translation shifts were less than 0.1 mm and rotation shifts were less than 0.1 degree. CONCLUSIONS Errors of a new 6DoF couch were tested using CBCT images of a 3D phantom. The rotation errors were less than 0.3 degree and the translation errors were less than or equal to 0.8 mm in each direction. This level of accuracy is warranted for clinical radiotherapy utilization including stereotactic radiosurgery.
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Affiliation(s)
- Qinghui Zhang
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Joseph Driewer
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Shuo Wang
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Sicong Li
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Xiaofeng Zhu
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Dandan Zheng
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Yijian Cao
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Jiaju Zhang
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Abolghassem Jamshidi
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Brett W Cox
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Jonathan P S Knisely
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Eric E Klein
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
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Li Y, Zhong R, Wang X, Ai P, Henderson F, Chen N, Luo F. Effects of online cone-beam computed tomography with active breath control in determining planning target volume during accelerated partial breast irradiation. Cancer Radiother 2017; 21:99-103. [PMID: 28325619 DOI: 10.1016/j.canrad.2016.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE To test if active breath control during cone-beam computed tomography (CBCT) could improve planning target volume during accelerated partial breast radiotherapy for breast cancer. METHODS Patients who were more than 40 years old, underwent breast-conserving dissection and planned for accelerated partial breast irradiation, and with postoperative staging limited to T1-2 N0 M0, or postoperative staging T2 lesion no larger than 3cm with a negative surgical margin greater than 2mm were enrolled. Patients with lobular carcinoma or extensive ductal carcinoma in situ were excluded. CBCT images were obtained pre-correction, post-correction and post-treatment. Set-up errors were recorded at left-right, anterior-posterior and superior-inferior directions. The differences between these CBCT images, as well as calculated radiation doses, were compared between patients with active breath control or free breathing. RESULTS Forty patients were enrolled, among them 25 had active breath control. A total of 836 CBCT images were obtained for analysis. CBCT significantly reduced planning target volume. However, active breath control did not show significant benefit in decreasing planning target volume margin and the doses of organ-at-risk when compared to free breathing. CONCLUSION CBCT, but not active breath control, could reduce planning target volume during accelerated partial breast irradiation.
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Affiliation(s)
- Y Li
- Department of Radiation Oncology, Cancer center, West China Hospital of Sichuan University, N(o). 37 Guoxuexiang, Wuhou District, Chengdu, 610041, China
| | - R Zhong
- Department of Radiation Oncology, Cancer center, West China Hospital of Sichuan University, N(o). 37 Guoxuexiang, Wuhou District, Chengdu, 610041, China
| | - X Wang
- Division of Breast Surgery, Department of Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - P Ai
- Department of Radiation Oncology, Cancer center, West China Hospital of Sichuan University, N(o). 37 Guoxuexiang, Wuhou District, Chengdu, 610041, China
| | - F Henderson
- University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - N Chen
- Department of Radiation Oncology, Cancer center, West China Hospital of Sichuan University, N(o). 37 Guoxuexiang, Wuhou District, Chengdu, 610041, China.
| | - F Luo
- Department of Radiation Oncology, Cancer center, West China Hospital of Sichuan University, N(o). 37 Guoxuexiang, Wuhou District, Chengdu, 610041, China
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Iskanderani O, Béliveau-Nadeau D, Doucet R, Coulombe G, Pascale D, Roberge D. Reproducibility of a Noninvasive System for Eye Positioning and Monitoring in Stereotactic Radiotherapy of Ocular Melanoma. Technol Cancer Res Treat 2017; 16:352-356. [PMID: 28168935 PMCID: PMC5616051 DOI: 10.1177/1533034617690979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose: Our preferred treatment for juxtapapillary choroidal melanoma is stereotactic radiotherapy. We aim to describe our immobilization system and quantify its reproducibility. Materials and Methods: Patients were identified in our radiosurgery database. Patients were imaged at computed tomography simulator with an in-house system which allows visual monitoring of the eye as the patient fixates a small target. All patients were reimaged at least once prior to and/or during radiotherapy. The patients were treated on the CyberKnife system, 60 Gy in 10 daily fractions, using skull tracking in conjunction with our visual monitoring system. In order to quantify the reproducibility of the eye immobilization system, computed tomography scans were coregistered using rigid 6-dimensional skull registration. Using the coregistered scans, x, y, and z displacements of the lens/optic nerve insertion were measured. From these displacements, 3-dimensional vectors were calculated. Results: Thirty-four patients were treated from October 2010 to September 2015. Thirty-nine coregistrations were performed using 73 scans (2-3 scans per patient). The mean displacements of lens and optic nerve insertion were 0.1 and 0.0 mm. The median 3-dimensional displacements (absolute value) of lens and nerve insertion were 0.8 and 0.7 mm (standard deviation: 0.5 and 0.6 mm). Ninety-eight percent of 3-dimensional displacements were below 2 mm (maximum 2.4 mm). The calculated planning target volume (PTV) margins were 0.8, 1.4, and 1.5 mm in the anterior–posterior, craniocaudal, and right–left axes, respectively. Following this analysis, no further changes have been applied to our planning margin of 2 to 2.5 mm as it is also meant to account for uncertainties in magnetic resonance imaging to computed tomography registration, skull tracking, and also contouring variability. Conclusion: We have found our stereotactic eye immobilization system to be highly reproducible (<1 mm) and free of systematic error.
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Affiliation(s)
- Omar Iskanderani
- 1 Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.,2 Department of Radiation Oncology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Dominique Béliveau-Nadeau
- 1 Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Robert Doucet
- 1 Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Geneviève Coulombe
- 1 Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Deborah Pascale
- 1 Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - David Roberge
- 1 Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
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McPartlin AJ, Li XA, Kershaw LE, Heide U, Kerkmeijer L, Lawton C, Mahmood U, Pos F, van As N, van Herk M, Vesprini D, van der Voort van Zyp J, Tree A, Choudhury A. MRI-guided prostate adaptive radiotherapy - A systematic review. Radiother Oncol 2016; 119:371-80. [PMID: 27162159 DOI: 10.1016/j.radonc.2016.04.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/08/2016] [Accepted: 04/09/2016] [Indexed: 11/29/2022]
Abstract
Dose escalated radiotherapy improves outcomes for men with prostate cancer. A plateau for benefit from dose escalation using EBRT may not have been reached for some patients with higher risk disease. The use of increasingly conformal techniques, such as step and shoot IMRT or more recently VMAT, has allowed treatment intensification to be achieved whilst minimising associated increases in toxicity to surrounding normal structures. To support further safe dose escalation, the uncertainties in the treatment target position will need be minimised using optimal planning and image-guided radiotherapy (IGRT). In particular the increasing usage of profoundly hypo-fractionated stereotactic therapy is predicated on the ability to confidently direct treatment precisely to the intended target for the duration of each treatment. This article reviews published studies on the influences of varies types of motion on daily prostate position and how these may be mitigated to improve IGRT in future. In particular the role that MRI has played in the generation of data is discussed and the potential role of the MR-Linac in next-generation IGRT is discussed.
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Affiliation(s)
- A J McPartlin
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - X A Li
- Medical College of Wisconsin, USA
| | - L E Kershaw
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - U Heide
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands
| | - L Kerkmeijer
- University Medical Center Utrecht, The Netherlands
| | - C Lawton
- Medical College of Wisconsin, USA
| | - U Mahmood
- MD Anderson Cancer Center, Houston, USA
| | - F Pos
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands
| | - N van As
- Royal Marsden Hospital, UK; Institute of Cancer Research, UK
| | - M van Herk
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - D Vesprini
- Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | | | - A Tree
- Royal Marsden Hospital, UK
| | - A Choudhury
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK.
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Sresty NVNM, Alluri K, Thogata R. A study of X-ray volume imaging system in image guided radiotherapy with variable gantry rotations. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2016. [DOI: 10.14319/ijcto.41.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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27
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Jeong S, Lee JH, Chung MJ, Lee SW, Lee JW, Kang DG, Kim SH. Analysis of Geometric Shifts and Proper Setup-Margin in Prostate Cancer Patients Treated With Pelvic Intensity-Modulated Radiotherapy Using Endorectal Ballooning and Daily Enema for Prostate Immobilization. Medicine (Baltimore) 2016; 95:e2387. [PMID: 26765418 PMCID: PMC4718244 DOI: 10.1097/md.0000000000002387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We evaluate geometric shifts of daily setup for evaluating the appropriateness of treatment and determining proper margins for the planning target volume (PTV) in prostate cancer patients.We analyzed 1200 sets of pretreatment megavoltage-CT scans that were acquired from 40 patients with intermediate to high-risk prostate cancer. They received whole pelvic intensity-modulated radiotherapy (IMRT). They underwent daily endorectal ballooning and enema to limit intrapelvic organ movement. The mean and standard deviation (SD) of daily translational shifts in right-to-left (X), anterior-to-posterior (Y), and superior-to-inferior (Z) were evaluated for systemic and random error.The mean ± SD of systemic error (Σ) in X, Y, Z, and roll was 2.21 ± 3.42 mm, -0.67 ± 2.27 mm, 1.05 ± 2.87 mm, and -0.43 ± 0.89°, respectively. The mean ± SD of random error (δ) was 1.95 ± 1.60 mm in X, 1.02 ± 0.50 mm in Y, 1.01 ± 0.48 mm in Z, and 0.37 ± 0.15° in roll. The calculated proper PTV margins that cover >95% of the target on average were 8.20 (X), 5.25 (Y), and 6.45 (Z) mm. Mean systemic geometrical shifts of IMRT were not statistically different in all transitional and three-dimensional shifts from early to late weeks. There was no grade 3 or higher gastrointestinal or genitourianry toxicity.The whole pelvic IMRT technique is a feasible and effective modality that limits intrapelvic organ motion and reduces setup uncertainties. Proper margins for the PTV can be determined by using geometric shifts data.
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Affiliation(s)
- Songmi Jeong
- From the Department of Radiation Oncology, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon (SJ, JHL, MJC, SWL, DGK, SHK); and Department of Radiation Oncology, Kyungpook National University Hospital, Daegu, Korea (JWL)
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Zhang Q, Tian S, Borasi G. A new definition of biological effective dose: The dose distribution effects. Phys Med 2015; 31:1060-1064. [DOI: 10.1016/j.ejmp.2015.07.145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/05/2015] [Accepted: 07/06/2015] [Indexed: 12/30/2022] Open
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Wang D, Abrams RA. Radiotherapy for soft tissue sarcoma: 50 years of change and improvement. Am Soc Clin Oncol Educ Book 2015:244-51. [PMID: 24857082 DOI: 10.14694/edbook_am.2014.34.244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Radiotherapy for soft tissue sarcoma (STS) has advanced significantly over the past 50 years. This review focuses briefly on the period from 1964 to 1999 and more substantially on the changes of the past 15 years, such as IMRT and image-guided radiotherapy (IG-RT), especially when brought together (IG-IMRT) in the same planning and delivery process to treat localized STS. In particular, the introduction of IG-RT, target volume definitions for IG-RT, and review of recent clinical trials using IG-RT to treat localized STS in extremity will be reviewed. Finally, potential investigational agents combined with IG-RT to improve outcomes in patients with localized STS are discussed.
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Affiliation(s)
- Dian Wang
- From the Department of Radiation Oncology, Rush University Medical Center, Chicago, IL
| | - Ross A Abrams
- From the Department of Radiation Oncology, Rush University Medical Center, Chicago, IL
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Sresty N, Ramanjappa T. Optimal usage of cone beam computed tomography system with different field of views in image guided radiotherapy (IGRT). INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2015. [DOI: 10.14319/ijcto.33.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Brouwer CL, Steenbakkers RJ, Langendijk JA, Sijtsema NM. Identifying patients who may benefit from adaptive radiotherapy: Does the literature on anatomic and dosimetric changes in head and neck organs at risk during radiotherapy provide information to help? Radiother Oncol 2015; 115:285-94. [DOI: 10.1016/j.radonc.2015.05.018] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 05/17/2015] [Accepted: 05/24/2015] [Indexed: 10/23/2022]
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Infusino E, Trodella L, Ramella S, D'Angelillo RM, Greco C, Iurato A, Trodella LE, Nacca A, Cornacchione P, Mameli A. Estimation of patient setup uncertainty using BrainLAB Exatrac X-Ray 6D system in image-guided radiotherapy. J Appl Clin Med Phys 2015; 16:5102. [PMID: 26103179 PMCID: PMC5690103 DOI: 10.1120/jacmp.v16i2.5102] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 11/18/2014] [Accepted: 11/10/2014] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to evaluate setup uncertainties for brain sites with ExacTrac X‐Ray 6D system and to provide optimal margin guidelines. Fifteen patients with brain tumor were included in this study. Two X‐ray images with ExacTrac X‐Ray 6D system were used to verify patient position and tumor target localization before each treatment. The 6D fusion software first generates various sets of DRRs with position variations in both three translational and three rotational directions (six degrees of freedom) for the CT images. Setup variations (translation and rotation) after correction were recorded and corrected before treatment. The 3D deviations are expressed as mean±standard deviation. The random error (Σ(σi)), systematic error (μi), and group systematic error (M(μi)) for the different X‐ray were calculated using the definitions of van Herk.(1) Mean setup errors were calculated from X‐ray images acquired after all fractions. There is moderate patient‐to‐patient variation in the vertical direction and small variations in systematic errors and magnitudes of random errors are smaller. The global systematic errors were measured to be less than 2.0 mm in each direction. Random component of all patients are smaller ranging from 0.1–0.3 mm small. The safety margin (SM) to the lateral, is 0.5 mm and 2.6 mm for van Herk(1) and Stroom et al.,(2) respectively, craniocaudal axis is 1.5 mm and 3.4 mm, respectively, and with respect to the antero–posterior axis, 2.3 mm and 3.9 mm. Daily X‐ray imaging is essential to compare and assess the accuracy of treatment delivery to different anatomical locations. PACS number: 87.55.D
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Zhang Q, Xiong W, Chan MF, Song Y, Burman C. Rotation effects on the target-volume margin determination. Phys Med 2015; 31:80-4. [DOI: 10.1016/j.ejmp.2014.10.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/04/2014] [Accepted: 10/12/2014] [Indexed: 10/24/2022] Open
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Poels K, Depuydt T, Verellen D, Gevaert T, Dhont J, Duchateau M, Burghelea M, Boussaer M, Steenbeke F, Collen C, Engels B, Storme G, De Ridder M. Improving the intra-fraction update efficiency of a correlation model used for internal motion estimation during real-time tumor tracking for SBRT patients: fast update or no update? Radiother Oncol 2014; 112:352-9. [PMID: 25443498 DOI: 10.1016/j.radonc.2014.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 09/08/2014] [Accepted: 09/16/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE For tumor tracking, a correlation model is used to estimate internal tumor position based on external surrogate motion. When patients experience an internal/external surrogate drift, an update of the correlation model is required to continue tumor tracking. In this study, the accuracy of the internal tumor position estimation for both the clinical available update at discrete points in time (rebuild) and an in-house developed non-clinical online update approach was investigated. METHODS A dynamic phantom with superimposed baseline drifts and 14 SBRT patients, treated with real-time tumor tracking (RTTT) on the Vero system, were retrospectively simulated for three update scenarios, respectively no update, clinical rebuild and 0.5 Hz automated online update of the correlation model. By comparing the target positions based on 0.5 Hz verification X-ray images with the estimated internal tumor positions regarding all three update scenarios, 95th percentile modeling errors (ME95), incidences of full geometrical coverage of the CTV by a 5 mm extended PTV (P₅mm) and population-based PTV margins were calculated. Further, the treatment time reduction was estimated when switching from the clinical rebuild approach to the online correlation model update. RESULTS For dynamic phantom motion with baseline drifts up to 0.4 mm/min, a 0.5 Hz intra-fraction update showed a similar accuracy in terms of ME95 and P5 mm compared to clinical rebuild. For SBRT patients treated on Vero with RTTT, accuracy was improved by 0.5 Hz online update compared to the clinical rebuild protocol, yielding smaller PTV margins (from 3.2 mm to 2.7 mm), reduced ME95,3D (from 4.1 mm to 3.4 mm) and an increased 5th percentile P5 mm (from 90.7% to 96.1%) for the entire patient group. Further, 80% of treatment sessions were reduced in time with on average 5.5 ± 4.1(1 SD)min. CONCLUSION With a fast (0.5 Hz) automated online update of the correlation model, an efficient RTTT workflow with improved geometrical accuracy was obtained.
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Affiliation(s)
- Kenneth Poels
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium.
| | - Tom Depuydt
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium; Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Verellen
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Thierry Gevaert
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Jennifer Dhont
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Michael Duchateau
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Manuela Burghelea
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Marlies Boussaer
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Femke Steenbeke
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Christine Collen
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Benedikt Engels
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Guy Storme
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Mark De Ridder
- Department Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
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Lefebvre L, Doré M, Giraud P. Nouvelles techniques et bénéfices attendus pour la radiothérapie du cancer du poumon. Cancer Radiother 2014; 18:473-9. [DOI: 10.1016/j.canrad.2014.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 06/23/2014] [Accepted: 06/27/2014] [Indexed: 12/25/2022]
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Zhang Q, Chan MF, Burman C, Song Y, Zhang M. Three independent one-dimensional margins for single-fraction frameless stereotactic radiosurgery brain cases using CBCT. Med Phys 2014; 40:121715. [PMID: 24320501 DOI: 10.1118/1.4829517] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Setting a proper margin is crucial for not only delivering the required radiation dose to a target volume, but also reducing the unnecessary radiation to the adjacent organs at risk. This study investigated the independent one-dimensional symmetric and asymmetric margins between the clinical target volume (CTV) and the planning target volume (PTV) for linac-based single-fraction frameless stereotactic radiosurgery (SRS). METHODS The authors assumed a Dirac delta function for the systematic error of a specific machine and a Gaussian function for the residual setup errors. Margin formulas were then derived in details to arrive at a suitable CTV-to-PTV margin for single-fraction frameless SRS. Such a margin ensured that the CTV would receive the prescribed dose in 95% of the patients. To validate our margin formalism, the authors retrospectively analyzed nine patients who were previously treated with noncoplanar conformal beams. Cone-beam computed tomography (CBCT) was used in the patient setup. The isocenter shifts between the CBCT and linac were measured for a Varian Trilogy linear accelerator for three months. For each plan, the authors shifted the isocenter of the plan in each direction by ±3 mm simultaneously to simulate the worst setup scenario. Subsequently, the asymptotic behavior of the CTV V80% for each patient was studied as the setup error approached the CTV-PTV margin. RESULTS The authors found that the proper margin for single-fraction frameless SRS cases with brain cancer was about 3 mm for the machine investigated in this study. The isocenter shifts between the CBCT and the linac remained almost constant over a period of three months for this specific machine. This confirmed our assumption that the machine systematic error distribution could be approximated as a delta function. This definition is especially relevant to a single-fraction treatment. The prescribed dose coverage for all the patients investigated was 96.1% ± 5.5% with an extreme 3-mm setup error in all three directions simultaneously. It was found that the effect of the setup error on dose coverage was tumor location dependent. It mostly affected the tumors located in the posterior part of the brain, resulting in a minimum coverage of approximately 72%. This was entirely due to the unique geometry of the posterior head. CONCLUSIONS Margin expansion formulas were derived for single-fraction frameless SRS such that the CTV would receive the prescribed dose in 95% of the patients treated for brain cancer. The margins defined in this study are machine-specific and account for nonzero mean systematic error. The margin for single-fraction SRS for a group of machines was also derived in this paper.
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Affiliation(s)
- Qinghui Zhang
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska 68198 and Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065
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Genovesi D, Ausili Cèfaro G, Trignani M, Vinciguerra A, Augurio A, Di Tommaso M, Perrotti F, De Paoli A, Olmi P, Valentini V, Di Nicola M. Interobserver variability of clinical target volume delineation in soft-tissue sarcomas. Cancer Radiother 2014; 18:89-96. [PMID: 24440683 DOI: 10.1016/j.canrad.2013.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 11/03/2013] [Accepted: 11/28/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE The present observational study reports the results of a multi-institutional dummy-run designed to estimate the consistency of interobserver variability in clinical target volume delineation in two different cases of soft-tissue sarcomas in which postoperative and preoperative radiotherapy were prescribed, respectively. The purpose of this work was to quantify interobserver variability in routine clinical practice. PATIENTS AND METHODS Two different cases of soft-tissues sarcomas were chosen: a case of postoperative and a case of preoperative radiation therapy. Participating centres were requested to delineate clinical target volumes according to their experience in both cases. Descriptive statistic was calculated for each variable (volume, diameters) separately for two cases. Box-whiskers plots were used for presentation of clinical target volume. A Shapiro-Wilk's test was performed to evaluate the departures from normality distribution for each variable. The comparison between relative variations of diameters was evaluated using the Student's t test. RESULTS Several variations affecting both volumes and diameters were observed. Main variations were observed in the craniocaudal and laterolateral diameters. Each case showed similar dispersion, indicating a lack of reproducibility in volumes definition. CONCLUSIONS This observational study highlighted that, in the absence of specific instructions or guidelines, the interobserver variability can be significant both in postoperative and preoperative radiotherapy of soft-tissue sarcomas.
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Affiliation(s)
- D Genovesi
- Department of Radiotherapy, SS. Annunziata Hospital, "G. D'Annunzio" University, via dei Vestini, 66100 Chieti, Italy.
| | - G Ausili Cèfaro
- Department of Radiotherapy, SS. Annunziata Hospital, "G. D'Annunzio" University, via dei Vestini, 66100 Chieti, Italy
| | - M Trignani
- Department of Radiotherapy, SS. Annunziata Hospital, "G. D'Annunzio" University, via dei Vestini, 66100 Chieti, Italy
| | - A Vinciguerra
- Department of Radiotherapy, SS. Annunziata Hospital, "G. D'Annunzio" University, via dei Vestini, 66100 Chieti, Italy
| | - A Augurio
- Department of Radiotherapy, SS. Annunziata Hospital, "G. D'Annunzio" University, via dei Vestini, 66100 Chieti, Italy
| | - M Di Tommaso
- Department of Radiotherapy, SS. Annunziata Hospital, "G. D'Annunzio" University, via dei Vestini, 66100 Chieti, Italy
| | - F Perrotti
- Department of Radiotherapy, SS. Annunziata Hospital, "G. D'Annunzio" University, via dei Vestini, 66100 Chieti, Italy
| | - A De Paoli
- Department of Radiotherapy C.R.O., Aviano, Italy
| | - P Olmi
- Department of Radiotherapy, Istituto Nazionale Tumori, Milano, Italy
| | - V Valentini
- Department of Radiotherapy "Cattolica Sacro Cuore" University, Roma, Italy
| | - M Di Nicola
- Department of Experimental and Clinical Sciences, Laboratory of Biostatistics, "G. D'Annunzio" University, Chieti, Italy
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Steroid-induced adaptive proton planning in a pediatric patient with low grade glioma: A case report and literature review. Pract Radiat Oncol 2014; 4:50-4. [DOI: 10.1016/j.prro.2013.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/06/2013] [Accepted: 06/07/2013] [Indexed: 11/22/2022]
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Dzintars E, Papanikolaou N, Mavroidis P, Sadeghi A, Stathakis S. Application of an independent dose calculation software for estimating the impact of inter-fractional setup shifts in Helical Tomotherapy treatments. Phys Med 2013; 29:615-23. [PMID: 23044458 DOI: 10.1016/j.ejmp.2012.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 09/04/2012] [Accepted: 09/10/2012] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study is to validate the capability of in-house independent point dose calculation software to be used as a second check for Helical Tomotherapy treatment plans. The software performed its calculations in homogenous conditions (using the Cheese phantom, which is a cylindrical phantom with radius 15 cm and length 18 cm) using a factor-based algorithm. Fifty patients, who were treated for pelvic (10), prostate (14), lung (10), head & neck (12) and brain (4) cancers, were used. Based on the individual patient kVCT images and the pretreatment MVCT images for each treatment fraction, the corresponding daily patient setup shifts in the IEC-X, IEC-Y, and IEC-Z directions were registered. For each patient, the registered fractional setup shifts were grouped into systematic and random shifts. The average systematic dosimetric variations showed small dose deviation for the different cancer types (1.0%-3.0%) compared to the planned dose. Of the fifty patients, only three had percent differences larger than 5%. The average random dosimetric variations showed relatively small dose deviations (0.2%-1.1%) compared to the planned dose. None of the patients had percent differences larger than 5%. By examining the individual fractions of each patient, it is observed that only in 31 out of 1358 fractions the percent differences exceeded the border of 5%. These results indicate that the overall dosimetric impact from systematic and random variations is small and that the software is a capable platform for independent point dose validation for the Helical Tomotherapy modality.
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Affiliation(s)
- Erik Dzintars
- Department of Radiation Oncology, University of Texas Health Science Center, San Antonio, TX, USA
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Zhang Q, Song Y, Chan M, Burman C, Yamada Y. Feasibility study of real-time planning for stereotactic radiosurgery. Med Phys 2013; 40:031711. [PMID: 23464306 DOI: 10.1118/1.4792637] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE 3D rotational setup errors in radiotherapy are often ignored by most clinics due to inability to correct or simulate them accurately and efficiently. There are two types of rotation-related problems in a clinical setting. One is to assess the affected dose distribution in real-time if correction is not applied and the other one is to correct the rotational setup errors prior to the initiation of the treatment. Here, the authors present the analytical solutions to both problems. METHODS (1) To assess the real-time dose distribution, eight stereotactic radiosurgery (SRS) cases were used as examples. For each plan, two new sets of beams with different table, gantry, and collimator angles were given in analytical forms as a function of patient rotational errors. The new beams simulate the rotational effects of the patient during the treatment setup. By using one arbitrary set of beams, SRS plans were recomputed with a series of different combinations of patient rotational errors, ranging from (-5°, -5°, -5°) to (5°, 5°, 5°) (roll, pitch, and yaw) with an increment of 1° and compared with those without rotational errors. For each set of rotational errors, its corresponding equivalent beams were computed using the analytical solutions and then used for dose calculation. (2) To correct for the rotational errors, two new sets of table, gantry, and collimator angles were derived analytically to validate the previously published derivation. However, in the derivation, a novel methodology was developed and two sets of table, gantry, and collimator angles were obtained in analytical forms. The solutions provide an alternative approach to rotational error correction by rotating the couch, gantry, and collimator rather than the patient. RESULTS For demonstration purpose, the above-derived new beams were implemented in a treatment planning system (TPS) to study the rotational effects on the SRS cases. For each case, the authors have generated ten additional plans that accounted for different rotations of the patient. They have found that rotations have an insignificant effect on the minimal, maximum, mean doses, and V80% of the planning target volume (PTV) when the rotations were relatively small. This was particularly true for the small and near-spherical targets. They, however, did change V95% significantly when the rotations approached 5°. The theory has been validated with clinical SRS cases and proven to be practical and viable. The preliminary results demonstrate that the rotational effects are patient-specific and depend on several important factors, such as the PTV size, the PTV location, and the beam configuration. The solutions given in this paper are of great potential values in clinical applications. CONCLUSIONS They have derived the analytical solutions to a new set of table, gantry, and collimator angles for a given treatment beam configuration as a function of patient rotational errors. One solution was used to assess the dosimetric effects of an imperfect patient setup and the other one was used to correct for the setup errors without rotating the patient. Compared to the widely adopted method of rotation effect assessment by importing the rotational CT images into TPS, the equivalent beam approach is simple and accurate. The analytical solutions to correcting for rotational setup errors prior to treatment were also derived. Based on the initial clinical investigations, they firmly believe that clinically viable real-time treatment planning and adaptive radiation therapy are feasible with this novel method.
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Affiliation(s)
- Qinghui Zhang
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
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Chen W, Gemmel A, Rietzel E. A patient-specific planning target volume used in 'plan of the day' adaptation for interfractional motion mitigation. JOURNAL OF RADIATION RESEARCH 2013; 54 Suppl 1:i82-i90. [PMID: 23824132 PMCID: PMC3700522 DOI: 10.1093/jrr/rrt070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/17/2013] [Accepted: 04/20/2013] [Indexed: 06/02/2023]
Abstract
We propose a patient-specific planning target volume (PTV) to deal with interfractional variations, and test its feasibility in a retrospective treatment-planning study. Instead of using one planning image only, multiple scans are taken on different days. The target and organs at risk (OARs) are delineated on each images. The proposed PTV is generated from a union of those target contours on the planning images, excluding voxels of the OARs, and is denoted the PTV 'GP-OAR' (global prostate-organs at risk). The study is performed using 'plan of the day' adaptive workflow, which selects a daily plan from a library of plans based on a similarity comparison between the daily scan and planning images. The daily plans optimized for GP-OAR volumes are compared with those optimized for PTVs generated from a single prostate contour (PTV SP). Four CT serials of prostate cancer patient datasets are included in the test, and in total 28 fractions are simulated. The results show that the daily chosen GP-OAR plans provide excellent target coverage, with V95 values of the prostate mostly > 95%. In addition, dose delivered to the OARs as calculated from applying daily chosen GP-OAR plans is slightly increased but comparable to that calculated from applying daily SP plans. In general, the PTV GP-OARs are able to cover possible target variations while keeping dose delivered to the OARs at a similar level to that of the PTV SPs.
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Affiliation(s)
- Wenjing Chen
- Universitäts Klinikum Heidelberg, Radiologische Klinik, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Van Gestel D, Verellen D, Van De Voorde L, de Ost B, De Kerf G, Vanderveken O, Van Laer C, Van den Weyngaert D, Vermorken JB, Gregoire V. The potential of helical tomotherapy in the treatment of head and neck cancer. Oncologist 2013; 18:697-706. [PMID: 23723331 PMCID: PMC4063397 DOI: 10.1634/theoncologist.2012-0424] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 03/27/2013] [Indexed: 12/28/2022] Open
Abstract
A decade after its first introduction into the clinic, little is known about the clinical impact of helical tomotherapy (HT) on head and neck cancer (HNC) treatment. Therefore, we analyzed the basics of this technique and reviewed the literature regarding HT's potential benefit in HNC. The past two decades have been characterized by a huge technological evolution in photon beam radiotherapy (RT). In HNC, static beam intensity-modulated radiotherapy (IMRT) has shown superiority over three-dimensional conformal RT in terms of xerostomia and is considered the standard of care. However, the next-generation IMRT, the rotational IMRT, has been introduced into the clinic without any evidence of superiority over static beam IMRT other than being substantially faster. Of these rotational techniques, HT is the first system especially developed for IMRT in combination with image-guided RT. HT is particularly promising for the treatment of HNC because its sharp dose gradients maximally spare the many radiosensitive organs at risk nearby. In addition, HT's integrated computed tomography scan assures a very precise dose administration and allows for some adaptive RT. Because HT is specifically developed for IMRT in combination with (integrated) image-guidance, it allows for precise dose distribution ("dose painting"), patient setup, and dose delivery. As such, it is an excellent tool for difficult HNC irradiation. The literature on the clinical results of HT in HNC all show excellent short-term (≤2 years) results with acceptable toxicity profiles. However, properly designed trials are still warranted to further substantiate these results.
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Affiliation(s)
- Dirk Van Gestel
- Department of Radiotherapy, University Radiotherapy Antwerp, Antwerp, Belgium.
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Yan D, Liang J. Expected treatment dose construction and adaptive inverse planning optimization: Implementation for offline head and neck cancer adaptive radiotherapy. Med Phys 2013; 40:021719. [DOI: 10.1118/1.4788659] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Required target margins for image-guided lung SBRT: Assessment of target position intrafraction and correction residuals. Pract Radiat Oncol 2013; 3:67-73. [DOI: 10.1016/j.prro.2012.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/08/2012] [Accepted: 03/09/2012] [Indexed: 02/06/2023]
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Paganelli C, Peroni M, Riboldi M, Sharp GC, Ciardo D, Alterio D, Orecchia R, Baroni G. Scale invariant feature transform in adaptive radiation therapy: a tool for deformable image registration assessment and re-planning indication. Phys Med Biol 2012; 58:287-99. [DOI: 10.1088/0031-9155/58/2/287] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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46
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Dosimetric evaluation of a three-phase adaptive radiotherapy for nasopharyngeal carcinoma using helical tomotherapy. Med Dosim 2012; 37:92-7. [DOI: 10.1016/j.meddos.2011.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 01/04/2011] [Accepted: 01/13/2011] [Indexed: 11/19/2022]
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Yi BSK, Perks J, Houston R, Stern R, Purdy JA, Chen AM. Changes in position and volume of lung cancer target volumes during stereotactic body radiotherapy (SBRT): is image guidance necessary? Technol Cancer Res Treat 2012; 10:495-504. [PMID: 21895034 DOI: 10.7785/tcrt.2012.500226] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to analyze inter- and intra-fractional changes in tumor volume with respect to both spatial and volumetric parameters among patients treated by SBRT for lung cancer. Twelve patients (13 tumors) were treated by SBRT with abdominal compression in 3-5 fractions over a 2 week period to a median dose of 60 Gy (range, 48 to 60 Gy). Kilovoltage cone-beam CT (CBCT) was obtained prior to the delivery of each fraction as well as intra-fractionally yielding a total of 55 CBCT scans. All CBCT scans were registered with the planning CT for target alignment and shifts were recorded and analyzed. Retrospectively, gross tumor volume (GTV) was contoured on all CBCT images and compared to initial planning volumes; positional differences were evaluated utilizing directional and vector analysis. Shifts greater than 5 mm were applied inter-fractionally in 6.8% (lateral), 29.5% (longitudinal), and 6.8% (vertical) of all delivered treatments. Using a 10 mm threshold, the corresponding percentages were 2.3%, 13.6%, and 2.3%, respectively. Across all fractions, the calculated inter-fractional shift vectors ranged from 0 to 31.2 mm, with 40.9%, 15.9%, and 11.4% of all fractions having shift vectors≥5 mm, ≥10 mm, and ≥20 mm, respectively. Intra-fractional shifts were also evaluated and found negligible in a small portion of patients evaluated. The mean overall reduction in GTV was 21.1% during SBRT. Significant changes in both position and volume occur during SBRT for lung cancer. Shifts (particularly in the superior-inferior axis) may exceed applied margins and compromise target coverage. Due to the extreme hypofractionation associated with SBRT, inter-fractional image guidance is necessary.
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Affiliation(s)
- B S K Yi
- Department of Radiation Oncology, University of California, Davis Cancer Center 4501 "X" St, G-140 Sacramento, CA 95817, USA
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Zhang Q, Chan M, Song Y, Burman C. Three Dimensional Expansion of Margins for Single-fraction Treatments: Stereotactic Radiosurgery Brain Cases. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ijmpcero.2012.12003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Uncertainties and CTV to PTV margins quantitative assessment using cone-beam CT technique in clinical application for prostate, and head and neck irradiation tumours. Clin Transl Oncol 2011; 13:819-25. [DOI: 10.1007/s12094-011-0740-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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50
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Saka B, Rardin RL, Langer MP, Dink D. Adaptive intensity modulated radiation therapy planning optimization with changing tumor geometry and fraction size limits. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/19488300.2011.609871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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