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Shimomura A, Wu T, Rusu I, Kishan AU, Tree AC, Solanki AA, Liauw SL. Monitoring Intrafraction Motion of the Prostate During Radiation Therapy: Suggested Practice Points From a Focused Review. Pract Radiat Oncol 2024; 14:146-153. [PMID: 37875222 DOI: 10.1016/j.prro.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE External beam radiation therapy to the prostate is typically delivered after verification of prostatic position with image guidance. Prostate motion can occur during the delivery of each radiation treatment between the time of localization imaging and completion of treatment. The objective of this work is to review the literature on intrafraction motion (IFM) of the prostate during radiation therapy and offer clinical recommendations on management. METHODS AND MATERIALS A comprehensive literature review was conducted on prostate motion during prostate cancer radiation therapy. Information was organized around 3 key clinical questions, followed by an evidence-based recommendation. RESULTS IFM of the prostate during radiation therapy is typically ≤3 mm and is unlikely to compromise prostate dosimetry to a clinically meaningful degree for men treated in a relatively short treatment duration with planning target volume (PTV) margins of ≥3 to 5 mm. IFM of 5 mm or more has been observed in up to ∼10% of treatment fractions, with limited dosimetric effect related to the infrequency of occurrence and longer fractionation of therapy. IFM can be monitored in continuous or discontinuous fashion with a variety of imaging platforms. Correction of IFM may have the greatest value when tighter PTV margins are desired (such as with stereotactic body radiation therapy or intraprostatic nodule boosting), ultrahypofractionated courses, or when treatment time exceeds several minutes. CONCLUSIONS This focused review summarizes literature and provides practical recommendations regarding IFM in the treatment of prostate cancer with external beam radiation therapy.
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Affiliation(s)
- Aoi Shimomura
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois
| | - Tianming Wu
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois
| | - Iris Rusu
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom
| | - Abhishek A Solanki
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois.
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2
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Schreuder A(N, Hsi W, Greenhalgh J, Kissick M, Lis M, Underwood TSA, Freeman H, Bauer M, Towe S, Mackie R. Anatomical changes in the male pelvis between the supine and upright positions-A feasibility study for prostate treatments in the upright position. J Appl Clin Med Phys 2023; 24:e14099. [PMID: 37488974 PMCID: PMC10647982 DOI: 10.1002/acm2.14099] [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: 10/31/2022] [Revised: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 07/26/2023] Open
Abstract
Treating and imaging patients in the upright orientation is gaining acceptance in radiation oncology and radiology and has distinct advantages over the recumbent position. An IRB approved study to investigate the positions and orientations of the male pelvic organs between the supine and upright positions was conducted. The study comprised of scanning 15 male volunteers (aged 55-75 years) on a 0.6 T Fonar MRI scanner in the supine and upright positions with a full bladder and in the upright position with an empty bladder. The Pelvic study revealed that in the upright position the 1. Position and shape of the prostate are not impacted significantly by bladder fill. 2. Distance between the sacrum and the anterior bladder wall is significantly smaller. 3. Anterior-Posterior length and the bladder width is significantly larger. 4. Seminal vesicles are pushed down by the bladder. 5. Top of the penile bulb is further away from the apex of the prostate. These observed differences could positively impact upright prostate treatments by 1. Reducing the risk of small bowel approximating the treatment volume. 2. Prostate treatments can be done with a reduced focus on bladder fill. 3. Radiation beams for treating intermediate risk prostrate can be made smaller or a larger portion of the seminal vesicles can be treated with the same beam size than typically used for supine treatments. 4. Reducing the average dose to the penile bulb.
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Affiliation(s)
| | - Wen‐Chien Hsi
- University of Arkansas for Medical Sciences (UAMS)Department of Radiation OncologyLittle Rock, ArkansasUSA
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Ballhausen H, Li M, Lombardo E, Landry G, Belka C. Planning CT Identifies Patients at Risk of High Prostate Intrafraction Motion. Cancers (Basel) 2023; 15:4103. [PMID: 37627131 PMCID: PMC10452220 DOI: 10.3390/cancers15164103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Prostate motion (standard deviation, range of motion, and diffusion coefficient) was calculated from 4D ultrasound data of 1791 fractions of radiation therapy in N = 100 patients. The inner diameter of the lesser pelvis was obtained from transversal slices through the pubic symphysis in planning CTs. On the lateral and craniocaudal axes, motility increases significantly (t-test, p < 0.005) with the inner diameter of the lesser pelvis. A diameter of >106 mm (ca. 6th decile) is a good predictor for high prostate intrafraction motion (ca. 9th decile). The corresponding area under the receiver operator curve (AUROC) is 80% in the lateral direction, 68% to 80% in the craniocaudal direction, and 62% to 70% in the vertical direction. On the lateral x-axis, the proposed test is 100% sensitive and has a 100% negative predictive value for all three characteristics (standard deviation, range of motion, and diffusion coefficient). On the craniocaudal z-axis, the proposed test is 79% to 100% sensitive and reaches 95% to 100% negative predictive value. On the vertical axis, the proposed test still delivers 98% negative predictive value but is not particularly sensitive. Overall, the proposed predictor is able to help identify patients at risk of high prostate motion based on a single planning CT.
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Affiliation(s)
- Hendrik Ballhausen
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, 81377 Munich, Germany
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Li Y, Gong Z, Liu M, Li H, Gao H, Guo C, Yu L, Zhu C, Sun Z, Sun L, Xu H, He X. 3D-US and CBCT Dual-guided Radiotherapy for Postoperative Uterine Malignancy: A Primary Workflow Set-up. Technol Cancer Res Treat 2023; 22:15330338231212082. [PMID: 37993995 PMCID: PMC10666818 DOI: 10.1177/15330338231212082] [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: 03/03/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 11/24/2023] Open
Abstract
Introduction: The consistency of clinical target volume is essential to guiding radiotherapy with precision for postoperative uterine malignancy patients. By introducing a three-dimensional ultrasound system (3D-US) into image-guided radiation therapy (IGRT), this study was designed to investigate the initial workflow set-up, the therapeutic potential, and the adverse events of 3D-US and cone-beam computed tomography (CBCT) dual-guided radiotherapy in postoperative uterine malignancy treatment. Methods: From April 2021 to December 2021, postoperative uterine malignancy patients were instructed to follow the previously standard protocol of daily radiation treatment, particularly a 3D-US (Clarity system) guiding was involved before CBCT. Soft-tissue-based displacements resulting from the additional US-IGRT were acquired in the LT (left)/RT (right), ANT (anterior)/POST (posterior), and SUP (superior)/INF(inferior) directions of the patient before fractional treatment. Displacement distributions before and after treatment either from 3D-US or from CBCT were also estimated and compared subsequently, and the urinary and rectal toxicity was further evaluated. Results: All the patients completed radiation treatment as planned. The assessment of 170 scans resulted in a mean displacement of (0.17 ± 0.24) cm, (0.19 ± 0.23) cm, (0.22 ± 0.26) cm for bladder in LT/RT, ANT/POST, and SUP/INF directions. A mean deviation of (0.26 ± 0.22) cm, (0.58 ± 0.5) cm, and (0.3 ± 0.23) cm was also observed for the bladder centroid between the CBCT and computed tomography -simulation images in three directions. Paired comparison between these two guidance shows that the variations from 3D-US are much smaller than those from CBCT in three directions, especially in ANT/POST and SUP/INF directions with significance (P = 0.000, 0.001, respectively). During treatment, and 0, 3, 6, 9, and 12 months after treatment, there was no severe urinary and rectal toxicity happened. Conclusion: A primary workflow of 3D-US and CBCT dual-guided radiotherapy has been established, which showed great therapeutic potential with mild to moderate urinary and rectal toxicity for postoperative uterine malignancy patients. But the clinical outcomes of this non-invasive technique need to be investigated further.
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Affiliation(s)
- Yang Li
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Zhen Gong
- Department of Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Mengyu Liu
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Huixin Li
- Department of Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Han Gao
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Chang Guo
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Le Yu
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Chenjing Zhu
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Zhihua Sun
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Li Sun
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Hanzi Xu
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Xia He
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
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Ong A, Knight K, Panettieri V, Dimmock M, Tuan JKL, Tan HQ, Master Z, Wright C. Application of an automated dose accumulation workflow in high-risk prostate cancer - validation and dose-volume analysis between planned and delivered dose. Med Dosim 2021; 47:92-97. [PMID: 34740517 DOI: 10.1016/j.meddos.2021.09.004] [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: 05/21/2021] [Revised: 07/28/2021] [Accepted: 09/09/2021] [Indexed: 10/19/2022]
Abstract
Inter-fraction organ variations cause deviations between planned and delivered doses in patients receiving radiotherapy for prostate cancer. This study compared planned (DP) vs accumulated doses (DA) obtained from daily cone-beam computed tomography (CBCT) scans in high-risk- prostate cancer with pelvic lymph nodes irradiation. An intensity-based deformable image registration algorithm used to estimate contours for DA was validated using geometrical agreement between radiation oncologist's and deformable image registration algorithm propagated contours. Spearman rank correlations (rs) between geometric measures and changes in organ volumes were evaluated for 20 cases. Dose-volume (DV) differences between DA and DP were compared (Wilcoxon rank test, p < 0.05). A novel region-of-interest (ROI) method was developed and mean doses were analyzed. Geometrical measures for the prostate and organ-at-risk contours were within clinically acceptable criteria. Inter-group mean (± SD) CBCT volumes for the rectum were larger compared to planning CT (pCT) (51.1 ± 11.3 cm3vs 46.6 ± 16.1 cm3), and were moderately correlated with variations in pCT volumes, rs = 0.663, p < 0.01. Mean rectum DV for DA was higher at V30-40 Gy and lower at V70-75 Gy, p < 0.05. Mean bladder CBCT volumes were smaller compared to pCT (198.8 ± 55 cm3vs 211.5 ± 89.1 cm3), and was moderately correlated with pCT volumes, rs = 0.789, p < 0.01. Bladder DA was higher at V30-65 Gy and lower at V70-75 Gy (p < 0.05). For the ROI method, rectum and bladder DA were lower at 5 to 10 mm (p < 0.01) as compared to DP, whilst bladder DA was higher than DP at 20 to 50 mm (p < 0.01). Generated DA demonstrated significant differences in organ-at-risk doses as compared to DP. A well-constructed workflow incorporating a ROI DV-extraction method has been validated in terms of efficiency and accuracy designed for seamless integration in the clinic to guide future plan adaptation.
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Affiliation(s)
- Ashley Ong
- National Cancer Centre Singapore, Division of Radiation Oncology, Singapore; Monash University, Department of Medical Imaging and Radiation Sciences, Clayton, Australia.
| | - Kellie Knight
- Monash University, Department of Medical Imaging and Radiation Sciences, Clayton, Australia
| | - Vanessa Panettieri
- Monash University, Department of Medical Imaging and Radiation Sciences, Clayton, Australia; Alfred Hospital, Alfred Health Radiation Oncology, Melbourne, Australia
| | - Mathew Dimmock
- Monash University, Department of Medical Imaging and Radiation Sciences, Clayton, Australia
| | | | - Hong Qi Tan
- National Cancer Centre Singapore, Division of Radiation Oncology, Singapore
| | - Zubin Master
- National Cancer Centre Singapore, Division of Radiation Oncology, Singapore
| | - Caroline Wright
- Monash University, Department of Medical Imaging and Radiation Sciences, Clayton, Australia
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6
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Cui H, Jiang X, Fang C, Zhu L, Yang Y. Planning CT-guided robust and fast cone-beam CT scatter correction using a local filtration technique. Med Phys 2021; 48:6832-6843. [PMID: 34662433 DOI: 10.1002/mp.15299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/27/2021] [Accepted: 10/11/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Cone-beam CT (CBCT) has been widely utilized in image-guided radiotherapy. Planning CT (pCT)-aided CBCT scatter correction could further enhance image quality and extend CBCT application to dose calculation and adaptive planning. Nevertheless, existing pCT-based approaches demand accurate registration between pCT and CBCT, leading to limited imaging performance and increased computational cost when large anatomical discrepancies exist. In this work, we proposed a robust and fast CBCT scatter correction method using local filtration technique and rigid registration between pCT and CBCT (LF-RR). METHODS First of all, the pCT was rigidly registered with CBCT, then forward projection was performed on registered pCT to create scatter-free projections. The raw scatter signals were obtained via subtracting the scatter-free projections from the measured CBCT projections. Based on frequency and intensity threshold criteria, reliable scatter signals were selected from the raw scatter signals, and further filtered for global scatter estimation via local filtration technique. Finally, corrected CBCT was reconstructed with the projections generated by subtracting the scatter estimation from the raw CBCT projections using FDK algorithm. The LF-RR method was evaluated via comparison with another pCT-based scatter correction method based on Median and Gaussian filters (MG method). RESULTS Proposed method was first validated on an anthropomorphic pelvis phantom, and showed satisfied performance on scatter removal even when anatomical mismatches were intentionally created on pCT. The quantitative analysis was further performed on four clinical CBCT images. Compared with the uncorrected CBCT, CBCT corrected by MG with rigid registration (MG-RR), MG with deformable registration (MG-DR), and LF-RR reduced the CT number error from 79 ± 35 to 25 ± 18 , 17 ± 13 and 7 ± 3 HU for adipose and from 115 ± 61 to 36 ± 22 , 30 ± 24 , 7 ± 3 HU for muscle, respectively. After correction, the spatial non-uniformity (SNU) of CBCT corrected with MG-RR, MG-DR and LF-RR was 51 ± 13 , 60 ± 21 , and 21 ± 9 HU for adipose, and 50 ± 22 , 57 ± 41 , and 25 ± 6 HU for muscle, respectively. Meanwhile, the contrast-to-noise ratio (CNR) between muscle and adipose was increased by a factor of 2.70, 2.89 and 2.56, respectively. Using the LF-RR method, the scatter correction of 656 projections can be finished within 10 s and the corrected volumetric images (200 slices) can be obtained within 2 min. CONCLUSION We developed a fast and robust pCT-based CBCT scatter correction method which exploits the local-filtration technique to promote the accuracy of scatter estimation and is resistant to pCT-to-CBCT registration uncertainties. Both phantom and patient studies showed the superiority of the proposed correction in imaging accuracy and computational efficiency, indicating promisingfuture clinical application.
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Affiliation(s)
- Hehe Cui
- Department of Engineering and Applied Physics, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiao Jiang
- Department of Engineering and Applied Physics, University of Science and Technology of China, Hefei, Anhui, China
| | - Chengyijue Fang
- Department of Engineering and Applied Physics, University of Science and Technology of China, Hefei, Anhui, China
| | - Lei Zhu
- Department of Engineering and Applied Physics, University of Science and Technology of China, Hefei, Anhui, China
| | - Yidong Yang
- Department of Radiation Oncology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.,Hefei National Laboratory for Physical Sciences at the Microscale & School of Physical Sciences, University of Science and Technology of China, Hefei, Anhui, China
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7
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Kilian-Meneghin J, Ma T, Kumaraswamy L. Impact of prostate focused alignment on planned pelvic lymph node dose. J Appl Clin Med Phys 2021; 22:27-35. [PMID: 34231945 PMCID: PMC8292696 DOI: 10.1002/acm2.13092] [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: 11/21/2018] [Revised: 09/13/2019] [Accepted: 10/06/2019] [Indexed: 11/11/2022] Open
Abstract
Purpose Prostate patients with positive lymph node margins receive an initial course of 45 Gy to the planning target volume (PTV) comprised of prostate, seminal vesicles, and lymph nodes with a 1‐cm margin. The prostate is localized via implanted fiducial markers before each fraction is delivered using portal‐imaging. However, the pelvic lymph nodes are affixed to the bony anatomy and are not mobile in concert with the prostate. The aim of this study was to determine whether a significant difference in pelvic lymph node coverage exists between planned and delivered external beam therapy treatments for these patients. Methods The recorded prostate motions were gathered for 19 patients; conjointly the pelvic lymph node motions were determined by manual registration of the bony anatomy in the kV‐images. The difference between the prostate and the bony anatomy coordinates was input into Eclipse as field shifts to represent the deviation in planned vs delivered pelvic lymph node coverage. Results Structure volume at V(100) was recorded for each patient for two structures: summed pelvic lymph nodes (LN CTV) and pelvic lymph nodes +1 cm margin (LN PTV) to express their contribution to the PTV. For the LN PTV, the average difference between the planned coverage and calculated delivered coverage was 3.5%, with a paired t‐test value of P = 0.005. Based upon bony anatomy registration, 26% of patients received less than 95% dose coverage using V(100) criteria for LN PTV. Dose value differences between the two plans at minimum were 6.96 ± 6.23 Gy, at mean were 0.54 ± 0.40 Gy, and at maximum were 0.10 ± 0.29 Gy. For the LN CTV, the average difference between the planned coverage and calculated delivered coverage was 1%, with a paired t‐test value of P = 0.53. Conclusions The results indicate a significant difference exists between the planned coverage and calculated delivered coverage for the LN PTV. There was no significant difference found for the LN CTV. We conclude that lymph node motion must be considered with the prostate motion when aligning patients before each fraction.
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Affiliation(s)
| | - Tianjun Ma
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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8
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Pang EPP, Knight K, Leung RW, Wang MLC, Chan JWS, Low GK, Seah IKL, Atan MAB, Chai JYH, Ng GC, Yang TC, Tuan JKL. Technical considerations for positioning and placement of a transperineal ultrasound probe during prostate radiotherapy. J Med Radiat Sci 2021; 68:196-202. [PMID: 33017863 PMCID: PMC8168066 DOI: 10.1002/jmrs.439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/07/2020] [Accepted: 09/14/2020] [Indexed: 01/01/2023] Open
Abstract
This technical evaluation aims to provide practice 'how to' guidelines for radiation therapists (RTs) when positioning a transperineal ultrasound (TPUS) probe during prostate radiotherapy. Recommendations and practical tips will be provided for the best practice in TPUS-guided workflow to obtain optimal ultrasound images for accurate interpretation and registration of the prostate gland. This will assist the RTs in making consistent and accurate clinical decision in an ultrasound-guided radiotherapy workflow for prostate treatment. The implementation process and the associated successes and challenges will also be described to assist institutions who may be investigating the potential of implementing this system.
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Affiliation(s)
- Eric Pei Ping Pang
- Division of Radiation OncologyNational Cancer Centre SingaporeSingaporeSingapore
- Faculty of Medicine, Nursing and Health SciencesDepartment of Medical Imaging & Radiation SciencesMonash UniversityClaytonVICAustralia
| | - Kellie Knight
- Faculty of Medicine, Nursing and Health SciencesDepartment of Medical Imaging & Radiation SciencesMonash UniversityClaytonVICAustralia
| | | | - Michael Lian Chek Wang
- Division of Radiation OncologyNational Cancer Centre SingaporeSingaporeSingapore
- Duke‐NUS Graduate Medical SchoolSingaporeSingapore
| | - Jason Wei Siang Chan
- Division of Radiation OncologyNational Cancer Centre SingaporeSingaporeSingapore
| | - Gee Keng Low
- Division of Radiation OncologyNational Cancer Centre SingaporeSingaporeSingapore
| | - Irene Kai Ling Seah
- Division of Radiation OncologyNational Cancer Centre SingaporeSingaporeSingapore
| | | | - Jairia Yih Huei Chai
- Division of Radiation OncologyNational Cancer Centre SingaporeSingaporeSingapore
| | - Grace Chuk‐Kwan Ng
- Department of Clinical OncologyTuen Mun HospitalTuen Mun, New TerritoriesHong Kong
| | | | - Jeffrey Kit Loong Tuan
- Division of Radiation OncologyNational Cancer Centre SingaporeSingaporeSingapore
- Duke‐NUS Graduate Medical SchoolSingaporeSingapore
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Ong A, Knight K, Panettieri V, Dimmock M, Tuan JKL, Tan HQ, Master Z, Wright C. Development of an automated radiotherapy dose accumulation workflow for locally advanced high-risk prostate cancer - A technical report. J Med Radiat Sci 2021; 68:203-210. [PMID: 33058720 PMCID: PMC8168070 DOI: 10.1002/jmrs.442] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/23/2022] Open
Abstract
An automated dose accumulation and contour propagation workflow using daily cone beam computed tomography (CBCTs) images for prostate cases that require pelvic lymph nodes irradiation (PLNs) was developed. This workflow was constructed using MIM® software with the intention to provide accurate dose transformations for plans with two different isocentres, whereby two sequential treatment phases were prescribed. The pre-processing steps for data extractions from treatment plans, CBCTs, determination of couch shift information and management of missing CBCTs are described. To ensure that the imported translational couch shifts were in the correct orientation and readable in MIM, phantom commissioning was performed. For dose transformation, rigid registration with corrected setup shifts and scaled fractional dose was performed for pCT to daily CBCTs, which were then deformed onto CBCT1 . Fractional dose summation resulted in the final accumulated dose for the patient allowing differences in dosimetry between the planned and accumulated dose to be analysed. Contour propagations of the prostate, bladder and rectum were performed within the same workflow. Transformed contours were then deformed onto daily CBCTs to generate trending reports for analysis, including Dice Similarity Coefficient (DSC) and Mean Distance to Agreement (MDA). Results obtained from phantom commissioning (DSC = 0.96, MDA = 0.89 mm) and geometrical analysis of the propagated contours for twenty patients; prostate (DSC: 0.9 ± 0.0, MDA: 1.0 ± 0.3 mm), rectum (DSC: 0.8 ± 0.1, mm, MDA: 1.7 ± 0.6 mm) and bladder (DSC: 0.8 ± 0.1, MDA: 2.8 ± 1.0 mm) were within clinically accepted tolerances for both DSC (>0.8) and MDA (< 0.3 mm). The developed workflow is being performed on a larger patient cohort for predictive model building, with the goal of correlating observed toxicity with the actual accumulated dose received by the patient.
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Affiliation(s)
- Ashley Ong
- Department of Radiation TherapyNational Cancer CentreSingapore
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonAustralia
| | - Kellie Knight
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonAustralia
| | - Vanessa Panettieri
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonAustralia
- Alfred Health Radiation OncologyAlfred HospitalMelbourneAustralia
| | - Matthew Dimmock
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonAustralia
| | | | - Hong Qi Tan
- Department of Radiation TherapyNational Cancer CentreSingapore
| | - Zubin Master
- Department of Radiation TherapyNational Cancer CentreSingapore
| | - Caroline Wright
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonAustralia
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10
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Nishioka K, Gotoh K, Hashimoto T, Abe T, Osawa T, Matsumoto R, Yokota I, Katoh N, Kinoshita R, Yasuda K, Yakabe T, Yoshimura T, Takao S, Shinohara N, Aoyama H, Shimizu S, Shirato H. Are simple verbal instructions sufficient to ensure that bladder volume does not deteriorate prostate position reproducibility during spot scanning proton therapy? BJR Open 2021; 3:20210064. [PMID: 35707757 PMCID: PMC9185850 DOI: 10.1259/bjro.20210064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/26/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives: The purpose of this study is to investigate whether verbal instructions are sufficient for bladder volume (BV) control not to deteriorate prostate position reproducibility in image-guided spot scanning proton therapy (SSPT) for localized prostate cancer. Methods: A total of 268 treatment sessions in 12 consecutive prostate cancer patients who were treated with image-guided SSPT with fiducial markers were retrospectively analyzed. In addition to strict rectal volume control procedures, simple verbal instructions to void urine one hour before the treatment were used here. The BV was measured by a Bladder Scan just before the treatment, and the prostate motion was measured by intraprostatic fiducial markers and two sets of X-ray fluoroscopy images. The correlation between the BV change and prostate motion was assessed by linear mixed-effects models and systematic and random errors according to the reproducibility of the BV. Results: The mean absolute BV change during treatment was from −98.7 to 86.3 ml (median 7.1 ml). The mean absolute prostate motion of the patients in the left-right direction was −1.46 to 1.85 mm; in the cranial-caudal direction it was −6.10 to 3.65 mm, and in the anteroposterior direction −1.90 to 5.23 mm. There was no significant relationship between the BV change and prostate motion during SSPT. The early and late genitourinary and gastrointestinal toxicity was minimal with a minimum follow up of 4.57 years. Conclusions: Simple verbal instructions about urination was suggested to be sufficient to control the BV not to impact on the prostate motion and clinical outcomes in image-guided SSPT. Careful attention to BV change is still needed when the seminal vesicle is to be treated. Advances in knowledge: Our data demonstrated that there was no apparent relationship between BV changes and prostate position reproducibility and simple verbal instruction about urination could be sufficient for image-guided SSPT.
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Affiliation(s)
- Kentaro Nishioka
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kento Gotoh
- Department of Radiation Medical Science and Engineering, Radiation Medical physics, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takayuki Hashimoto
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takashige Abe
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine / School of Medicine, Sapporo, Hokkaido, Japan
| | - Takahiro Osawa
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine / School of Medicine, Sapporo, Hokkaido, Japan
| | - Ryuji Matsumoto
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine / School of Medicine, Sapporo, Hokkaido, Japan
| | - Isao Yokota
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Rumiko Kinoshita
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Koichi Yasuda
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Toshiaki Yakabe
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Takaaki Yoshimura
- Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Seishin Takao
- Department of Radiation Medical Science and Engineering, Radiation Medical physics, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine / School of Medicine, Sapporo, Hokkaido, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Shinichi Shimizu
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiroki Shirato
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Dosimetric evaluation of whole-pelvis radiation therapy of prostate cancers: clinical experience. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:The standard treatment modalities for prostate cancer include surgery, chemotherapy, hormonal therapy and radiation therapy or any combination depending on the stage of the tumour. Radiation therapy is a common and effective treatment modality for low-intermediate-risk patients with localised prostate cancer, to treat the intact prostate and seminal vesicles or prostate bed post prostatectomy. However, for high-risk patients with lymph node involvement, treatment with radiation will usually include treatment of the whole pelvis to cover the prostate and seminal vesicles or prostate bed and the pelvic lymph nodes followed by a boost delivery dose to the prostate and seminal vesicles or prostate bed.Materials and Methods:We retrospectively analysed the treatment plans for 179 prostate cancer patients treated at the cancer centre with the volumetric-modulated arc therapy (VMAT) technique via RapidArc using 6 MV photon beam. Patients were either treated with a total prescription dose of 78 Gy in 39 fractions for patients with intact prostate or 66 Gy in 33 fractions for post prostatectomy patients.Results:There were 114 (64%) patients treated with 78 Gy/39 and 65 (36%) treated with 66 Gy/34. The mean homogeneity index (HI), conformity index (CI) and uniformity index (UI) for the PTV-primary of patients treated with 78 Gy are 0.06 ± 0.01, 1.04 ± 0.01 and 0.99 ± 0.01, respectively, and the corresponding mean values for patients treated with 66 Gy are 0.06 ± 0.02, 1.05 ± 0.01 and 0.99 ± 0.01, respectively. The mean PTV-primary V95%, V100% and V105% are 99.5 ± 0.5%, 78.8 ± 12.2% and 0.1 ± 0.5%, respectively, for patients treated with 78 Gy and 99.3 ± 0.9%, 78.1 ± 10.6% and 0.1 ± 0.4%, respectively, for patients treated with 66 Gy. The rectal V50Gy, V65Gy, V66.6Gy, V70Gy, V75Gy and V80Gy are 26.8 ± 9.1%, 14.2 ± 5.3%, 13.1 ± 5.0%, 10.8 ± 4.3%, 6.9 ± 3.1% and 0.1 ± 0.1%, respectively, for patients treated with 78 Gy and 33.7 ± 8.4%, 14.1 ± 4.5%, 6.7 ± 4.5%, 0.0 ± 0.2%, 0.0% and 0.0%, respectively, for patients treated with 66 Gy.Conclusion:The use of VMAT technique for radiation therapy of high-risk prostate cancer patients is an efficient and reliable method for achieving superior dose conformity, uniformity and homogeneity to the PTV and minimal doses to the organs at risk. Results from this study provide the basis for the development and implementation of consistent treatment criteria in radiotherapy programs, have the potential to establish an evaluation process to define a consistent, standardised and transparent treatment path for all patients that reduces significant variations in the acceptability of treatment plans and potentially improve patient standard of care.
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Jmour O, Benna M, Champagnol P, Ben Mrad M, Hamrouni A, Obeid L, Lahmamssi C, Bousarsar A, Vial N, Rehailia-Blanchard A, Sotton S, Lan M, Langrand-Escure J, Vallard A, Magné N. CBCT evaluation of inter- and intra-fraction motions during prostate stereotactic body radiotherapy: a technical note. Radiat Oncol 2020; 15:85. [PMID: 32307017 PMCID: PMC7168857 DOI: 10.1186/s13014-020-01534-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/08/2020] [Indexed: 12/28/2022] Open
Abstract
Background In most clinical trials, gold fiducial markers are implanted in the prostate to tune the table position before each radiation beam. Yet, it is unclear if a cone-beam computed tomography (CBCT) should be performed before each beam to monitor a possible variation of the organs at risk (OARs) fullness, especially in case of recto-prostatic spacer implantation. The present study aimed at assessing the inter- and intra-fraction movements of prostate, bladder and rectum in patients implanted with a hyaluronic acid spacer and undergoing prostate stereotactic body radiotherapy (SBRT). Methods Data about consecutive patients undergoing prostate SBRT were prospectively collected between 2015 and 2019. Inter-and intra-fraction prostate displacements and volume variation of organs at risk (OARs) were assessed with CBCTs. Results Eight patients were included. They underwent prostate SBRT (37.5Gy, 5 fractions of 7.5Gy) guided by prostate gold fiducial markers. Inter-fraction variation of the bladder volume was insignificant. Intra-fraction mean increase of the bladder volume was modest (29 cc) but significant (p < 0.001). Both inter- and intra-fraction variations of the rectum volume were insignificant but for one patient. He had no rectal toxicity. The magnitude of table displacement necessary to match the prostate gold fiducial marker frequently exceeded the CTV/PTV margins (0.4 cm) before the first (35%) and the second arc (15%). Inter- and intra-fraction bladder and rectum volume variations did not correlate with prostate displacement. Conclusion Major prostate position variations were reported. In-room kV fiducial imaging before each arc seems mandatory. Intra-fraction imaging of the OARs appears unnecessary. We suggest that only one CBCT is needed before the first arc. Trial registration NCT02361515, February 11th, 2015.
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Affiliation(s)
- Omar Jmour
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Marouan Benna
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Pierre Champagnol
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Majed Ben Mrad
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Anis Hamrouni
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Layal Obeid
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Chaimaa Lahmamssi
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Amal Bousarsar
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Nicolas Vial
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Amel Rehailia-Blanchard
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Sandrine Sotton
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Meiling Lan
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Julien Langrand-Escure
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Alexis Vallard
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Nicolas Magné
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France.
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Nejad‐Davarani SP, Sevak P, Moncion M, Garbarino K, Weiss S, Kim J, Schultz L, Elshaikh MA, Renisch S, Glide‐Hurst C. Geometric and dosimetric impact of anatomical changes for MR-only radiation therapy for the prostate. J Appl Clin Med Phys 2019; 20:10-17. [PMID: 30821881 PMCID: PMC6448347 DOI: 10.1002/acm2.12551] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE With the move towards magnetic resonance imaging (MRI) as a primary treatment planning modality option for men with prostate cancer, it becomes critical to quantify the potential uncertainties introduced for MR-only planning. This work characterized geometric and dosimetric intra-fractional changes between the prostate, seminal vesicles (SVs), and organs at risk (OARs) in response to bladder filling conditions. MATERIALS AND METHODS T2-weighted and mDixon sequences (3-4 time points/subject, at 1, 1.5 and 3.0 T with totally 34 evaluable time points) were acquired in nine subjects using a fixed bladder filling protocol (bladder void, 20 oz water consumed pre-imaging, 10 oz mid-session). Using mDixon images, Magnetic Resonance for Calculating Attenuation (MR-CAT) synthetic computed tomography (CT) images were generated by classifying voxels as muscle, adipose, spongy, and compact bone and by assignment of bulk Hounsfield Unit values. Organs including the prostate, SVs, bladder, and rectum were delineated on the T2 images at each time point by one physician. The displacement of the prostate and SVs was assessed based on the shift of the center of mass of the delineated organs from the reference state (fullest bladder). Changes in dose plans at different bladder states were assessed based on volumetric modulated arc radiotherapy (VMAT) plans generated for the reference state. RESULTS Bladder volume reduction of 70 ± 14% from the final to initial time point (relative to the final volume) was observed in the subject population. In the empty bladder condition, the dose delivered to 95% of the planning target volume (PTV) (D95%) reduced significantly for all cases (11.53 ± 6.00%) likely due to anterior shifts of prostate/SVs relative to full bladder conditions. D15% to the bladder increased consistently in all subjects (42.27 ± 40.52%). Changes in D15% to the rectum were patient-specific, ranging from -23.93% to 22.28% (-0.76 ± 15.30%). CONCLUSIONS Variations in the bladder and rectal volume can significantly dislocate the prostate and OARs, which can negatively impact the dose delivered to these organs. This warrants proper preparation of patients during treatment and imaging sessions, especially when imaging required longer scan times such as MR protocols.
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Affiliation(s)
| | - Parag Sevak
- The Cancer CenterColumbus Regional HealthColumbusINUSA
| | - Michael Moncion
- Radiation Oncology DepartmentSt. Jude Children's Research HospitalMemphisTNUSA
| | | | - Steffen Weiss
- Department of Digital ImagingPhilips Research LaboratoriesHamburgGermany
| | - Joshua Kim
- Department of Radiation OncologyHenry Ford Cancer InstituteDetroitMIUSA
| | - Lonni Schultz
- Department of Public Health SciencesHenry Ford Health SystemDetroitMIUSA
| | | | - Steffen Renisch
- Department of Digital ImagingPhilips Research LaboratoriesHamburgGermany
| | - Carri Glide‐Hurst
- Department of Radiation OncologyHenry Ford Cancer InstituteDetroitMIUSA
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