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Tan HQ, Koh CWY, Lew KS, Yeap PL, Chua CGA, Lee JKH, Wibawa A, Master Z, Lee JCL, Park SY. Real-time gated proton therapy with a reduced source to imager distance: Commissioning and quality assurance. Phys Med 2024; 122:103380. [PMID: 38805761 DOI: 10.1016/j.ejmp.2024.103380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/12/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION Real-time gated proton therapy (RGPT) is a motion management technique unique to the Hitachi particle therapy system. It uses pulsed fluoroscopy to track an implanted fiducial marker. There are currently no published guidelines on how to conduct the commissioning and quality assurance. In this work we reported on our centre's commissioning workflow and our daily and monthly QA procedures. METHODS Six commissioning measurements were designed for RGPT. The measurements include imaging qualities, fluoroscopic exposures, RGPT marker tracking accuracy, temporal gating latency, fiducial marker tracking fidelity and an end-to-end proton dosimetry measurement. Daily QA consists of one measurement on marker localization accuracy. Four months daily QA trends are presented. Monthly QA consists of three measurementson the gating latency, fluoroscopy imaging quality and dosimetry verification of gating operation with RGPT. RESULTS The RGPT was successfully commissioned in our centre. The air kerma rates were within 15 % from specifications and the marker tracking accuracies were within 0.245 mm. The gating latencies for turning the proton beam on and off were 119.5 and 50.0 ms respectively. The 0.4x10.0 mm2 Gold AnchorTM gave the best tracking results with visibility up to 30 g/cm2. Gamma analysis showed that dose distribution of a moving and static detectors had a passing rate of more than 95 % at 3 %/3mm. The daily marker localization QA results were all less than 0.2 mm. CONCLUSION This work could serve as a good reference for other upcoming Hitachi particle therapy centres who are interested to use RGPT as their motion management solution.
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Affiliation(s)
- Hong Qi Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore.
| | | | - Kah Seng Lew
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Ping Lin Yeap
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | | | | | - Andrew Wibawa
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Zubin Master
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | | | - Sung Yong Park
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
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Tominaga Y, Suga M, Takeda M, Yamamoto Y, Akagi T, Kato T, Tokumaru S, Yamamoto M, Oita M. Comparing interplay effects in scanned proton therapy of lung cancer: Free breathing with various layer and volume rescanning versus respiratory gating with different gate widths. Phys Med 2024; 120:103323. [PMID: 38461635 DOI: 10.1016/j.ejmp.2024.103323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/07/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024] Open
Abstract
PURPOSE We investigated interplay effects and treatment time (TT) in scanned proton therapy for lung cancer patients. We compared free-breathing (FB) approaches with multiple rescanning strategies and respiratory-gating (RG) methods with various gating widths to identify the superior irradiation technique. METHODS Plans were created with 4/1, 2/2, and 1/4 layered/volume rescans of FB (L4V1, L2V2, and L1V4), and 50%, 30%, and 10% gating widths of the total respiratory curves (G50, G30, and G10) of the RG plans with L4V1. We calculated 4-dimensional dynamic doses assuming a constant sinusoidal curve for six irradiation methods. The reconstructed doses per fraction were compared with planned doses in terms of dose differences in 99% clinical-target-volume (CTV) (ΔD99%), near-maximum dose differences (ΔD2%) at organs-at-risk (OARs), and TT. RESULTS The mean/minimum CTV ΔD99% values for FB were -1.0%/-4.9%, -0.8%/-4.3%, and -0.1%/-1.0% for L4V1, L2V2, and L1V4, respectively. Those for RG were -0.3%/-1.7%, -0.1%/-1.0%, and 0.0%/-0.5% for G50, G30, and G10, respectively. The CTV ΔD99% of the RGs with less than 50% gate width and the FBs of L1V4 were within the desired tolerance (±3.0%), and the OARs ΔD2% for RG were lower than those for FB. The mean TTs were 90, 326, 824, 158, 203, and 422 s for L4V1, L2V2, L1V4, G50, G30, and G10, respectively. CONCLUSIONS FB (L4V1) is the most efficient treatment, but not necessarily the optimal choice due to interplay effects. To satisfy both TT extensions and interplay, RG with a gate width as large as possible within safety limits is desirable.
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Affiliation(s)
- Yuki Tominaga
- Department of Radiotherapy, Medical Co. Hakuhokai, Osaka Proton Therapy Clinic, 27-9 Kasugadenaka, Konohana-ku, Osaka 554-0022, Japan.
| | - Masaki Suga
- Hyogo Ion Beam Medical Center, 1-2-1, Kouto, Shingucho, Tatsuno, Hyogo 679-5165, Japan
| | - Mikuni Takeda
- Hyogo Ion Beam Medical Center, 1-2-1, Kouto, Shingucho, Tatsuno, Hyogo 679-5165, Japan
| | - Yuki Yamamoto
- Hyogo Ion Beam Medical Center, 1-2-1, Kouto, Shingucho, Tatsuno, Hyogo 679-5165, Japan
| | - Takashi Akagi
- Hyogo Ion Beam Medical Support, 1-2-1, Kouto, Shingucho, Tatsuno, Hyogo 679-5165, Japan
| | - Takahiro Kato
- Department of Radiological Sciences, School of Health Sciences, Fukushima Medical University, 1 Hikariga-oka, Fukushima 960-1295, Japan; Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima 172, Yatsuyamada 7 Chome, Koriyama, Fukushima 963-8052, Japan
| | - Sunao Tokumaru
- Hyogo Ion Beam Medical Center, 1-2-1, Kouto, Shingucho, Tatsuno, Hyogo 679-5165, Japan
| | - Michinori Yamamoto
- Department of Radiotherapy, Medical Co. Hakuhokai, Osaka Proton Therapy Clinic, 27-9 Kasugadenaka, Konohana-ku, Osaka 554-0022, Japan
| | - Masataka Oita
- Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University, 5-1 Shikata-cho, 2-chome, Kita-ku, Okayama 700-8558, Japan
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Park J, Gagneur JD, Chungbin SJ, Rong Y, Lim SB, Chan MF. Resolving signal drift in the wall-mounted camera of the RGSC system. J Appl Clin Med Phys 2024; 25:e14291. [PMID: 38306504 PMCID: PMC10929989 DOI: 10.1002/acm2.14291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 02/04/2024] Open
Abstract
PURPOSE To present a modified calibration method to reduce signal drift due to table sagging in Respiratory Gating for Scanner (RGSC) systems with a wall-mounted camera. MATERIALS AND METHODS Approximately 70 kg of solid water phantoms were evenly distributed on the CT couch, mimicking the patient's weight. New calibration measurements were performed at 9 points at the combination of three lateral positions, the CT isocenter and ±10 cm laterally from the isocenter, and three longitudinal locations, the CT isocenter and ±30 cm or ±40 cm from the isocenter. The new calibration was tested in two hospitals. RESULTS Implementing the new weighed calibration method at the extended distance yielded improved results during the DIBH scan, reducing the drift to within 1 from 3 mm. The extended calibration positions exhibited similarly reduced drift in both hospitals, reinforcing the method's robustness and its potential applicability across all centers. CONCLUSION This proposed solution aims to minimize the systematic error in radiation delivery for patients undergoing motion management with wall-mounted camera RGSC systems, especially in conjunction with a bariatric CT couchtop.
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Affiliation(s)
- Jeonghoon Park
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterBasking RidgeNew JerseyUSA
| | | | | | - Yi Rong
- Department of Radiation OncologyMayo ClinicPhoenixArizonaUSA
| | - Seng Boh Lim
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterBasking RidgeNew JerseyUSA
| | - Maria F. Chan
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterBasking RidgeNew JerseyUSA
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Qubala A, Shafee J, Tessonnier T, Horn J, Winter M, Naumann J, Jäkel O. Characteristics of breathing-adapted gating using surface guidance for use in particle therapy: A phantom-based end-to-end test from CT simulation to dose delivery. J Appl Clin Med Phys 2024; 25:e14249. [PMID: 38128056 PMCID: PMC10795430 DOI: 10.1002/acm2.14249] [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: 10/10/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
To account for intra-fractional tumor motion during dose delivery in radiotherapy, various treatment strategies are clinically implemented such as breathing-adapted gating and irradiating the tumor during specific breathing phases. In this work, we present a comprehensive phantom-based end-to-end test of breathing-adapted gating utilizing surface guidance for use in particle therapy. A commercial dynamic thorax phantom was used to reproduce regular and irregular breathing patterns recorded by the GateRT respiratory monitoring system. The amplitudes and periods of recorded breathing patterns were analysed and compared to planned patterns (ground-truth). In addition, the mean absolute deviations (MAD) and Pearson correlation coefficients (PCC) between the measurements and ground-truth were assessed. Measurements of gated and non-gated irradiations were also analysed with respect to dosimetry and geometry, and compared to treatment planning system (TPS). Further, the latency time of beam on/off was evaluated. Compared to the ground-truth, measurements performed with GateRT showed amplitude differences between 0.03 ± 0.02 mm and 0.26 ± 0.03 mm for regular and irregular breathing patterns, whilst periods of both breathing patterns ranged with a standard deviation between 10 and 190 ms. Furthermore, the GateRT software precisely acquired breathing patterns with a maximum MAD of 0.30 ± 0.23 mm. The PCC constantly ranged between 0.998 and 1.000. Comparisons between TPS and measured dose profiles indicated absolute mean dose deviations within institutional tolerances of ±5%. Geometrical beam characteristics also varied within our institutional tolerances of 1.5 mm. The overall time delays were <60 ms and thus within both recommended tolerances published by ESTRO and AAPM of 200 and 100 ms, respectively. In this study, a non-invasive optical surface-guided workflow including image acquisition, treatment planning, patient positioning and gated irradiation at an ion-beam gantry was investigated, and shown to be clinically viable. Based on phantom measurements, our results show a clinically-appropriate spatial, temporal, and dosimetric accuracy when using surface guidance in the clinical setting, and the results comply with international and institutional guidelines and tolerances.
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Affiliation(s)
- Abdallah Qubala
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- Faculty of MedicineUniversity of HeidelbergHeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
| | - Jehad Shafee
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- Saarland University of Applied SciencesSaarbrueckenGermany
| | - Thomas Tessonnier
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
| | - Julian Horn
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
| | - Marcus Winter
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
| | - Jakob Naumann
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
| | - Oliver Jäkel
- Heidelberg Ion Beam Therapy Center (HIT)HeidelbergGermany
- National Center for Radiation Research in Oncology (NCRO)Heidelberg Institute of Radiation Oncology (HIRO)HeidelbergGermany
- Department of Medical Physics in Radiation OncologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
- National Center for Tumor Diseases (NCT)HeidelbergGermany
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Butz I, Fernandez M, Uneri A, Theodore N, Anderson WS, Siewerdsen JH. Performance assessment of surgical tracking systems based on statistical process control and longitudinal QA. Comput Assist Surg (Abingdon) 2023; 28:2275522. [PMID: 37942523 DOI: 10.1080/24699322.2023.2275522] [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] [Indexed: 11/10/2023] Open
Abstract
A system for performance assessment and quality assurance (QA) of surgical trackers is reported based on principles of geometric accuracy and statistical process control (SPC) for routine longitudinal testing. A simple QA test phantom was designed, where the number and distribution of registration fiducials was determined drawing from analytical models for target registration error (TRE). A tracker testbed was configured with open-source software for measurement of a TRE-based accuracy metric ε and Jitter (J ). Six trackers were tested: 2 electromagnetic (EM - Aurora); and 4 infrared (IR - 1 Spectra, 1 Vega, and 2 Vicra) - all NDI (Waterloo, ON). Phase I SPC analysis of Shewhart mean (x ¯ ) and standard deviation (s ) determined system control limits. Phase II involved weekly QA of each system for up to 32 weeks and identified Pass, Note, Alert, and Failure action rules. The process permitted QA in <1 min. Phase I control limits were established for all trackers: EM trackers exhibited higher upper control limits than IR trackers in ε (EM: x ¯ ε ∼ 2.8-3.3 mm, IR: x ¯ ε ∼ 1.6-2.0 mm) and Jitter (EM: x ¯ jitter ∼ 0.30-0.33 mm, IR: x ¯ jitter ∼ 0.08-0.10 mm), and older trackers showed evidence of degradation - e.g. higher Jitter for the older Vicra (p-value < .05). Phase II longitudinal tests yielded 676 outcomes in which a total of 4 Failures were noted - 3 resolved by intervention (metal interference for EM trackers) - and 1 owing to restrictive control limits for a new system (Vega). Weekly tests also yielded 40 Notes and 16 Alerts - each spontaneously resolved in subsequent monitoring.
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Affiliation(s)
- I Butz
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - M Fernandez
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - A Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - N Theodore
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - W S Anderson
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Actis O, Mayor A, Meer D, Rechsteiner U, Bolsi A, Lomax AJ, Weber DC. A bi-directional beam-line energy ramping for efficient patient treatment with scanned proton therapy. Phys Med Biol 2023; 68:175001. [PMID: 37506707 DOI: 10.1088/1361-6560/acebb2] [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: 04/04/2023] [Accepted: 07/28/2023] [Indexed: 07/30/2023]
Abstract
Objective.The treatment of mobile tumours using Pencil Beam Scanning (PBS) has become more prevalent in the last decade. However, to achieve the same beam delivery quality as for static tumours, treatments have to be combined with motion mitigation techniques, not limited but including, breath hold, gating and re-scanning, which typically prolong treatment time. In this article we present a novel method of bi-directional energy modulation and demonstrate our initial experience in improvement of treatment efficiency. Approach.At Paul Scherrer Institute Gantry 2 mobile tumours are treated by combining PBS with gating and volumetric re-scanning (VR), where the target volume is irradiated multiple times. Initial implementation of VR used only descending beam energies, creating a substantial dead time due to the beam-line initialization (ramping) before each re-scan. In 2019 we commissioned an energy meandering strategy that allows us to avoid beam line ramping in-between energy series while maintaining beam delivery quality.Main results.The measured beam parameters difference for both energy sequence are in the order of the typical daily variations: 0.2 mm in beam position and 0.2 mm in range. Using machine log files, we performed point-to-point dose difference calculations between original and new applications where we observed dose differences of less than 2%. After three years of operation employing bi-directional energy modulation, we have analysed the individual beam delivery time for 181 patients and have compared this to simulations of the timing behaviour assuming uni-directional energy sequence application. Depending on treatment complexity, we obtained plan delivery time reductions of up to 55%, with a median time gain of 17% for all types of treatments.Significance. Bi-directional energy modulation can help improving patient treatment efficiency by reducing delivery times especially for complex and specialised irradiations. It could be implemented in many existing facilities without significant additional hardware upgrades.
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Affiliation(s)
- Oxana Actis
- Center for Proton Therapy, Paul Scherrer Institut, Switzerland
| | - Alexandre Mayor
- Center for Proton Therapy, Paul Scherrer Institut, Switzerland
| | - David Meer
- Center for Proton Therapy, Paul Scherrer Institut, Switzerland
| | - Urs Rechsteiner
- Center for Proton Therapy, Paul Scherrer Institut, Switzerland
| | | | - Antony John Lomax
- Center for Proton Therapy, Paul Scherrer Institut, Switzerland
- ETH Zurich, Switzerland
| | - Damien Charles Weber
- Center for Proton Therapy, Paul Scherrer Institut, Switzerland
- University Hospital Zurich, Switzerland
- University Hospital Bern, University of Bern, Switzerland
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Graeff C, Volz L, Durante M. Emerging technologies for cancer therapy using accelerated particles. PROGRESS IN PARTICLE AND NUCLEAR PHYSICS 2023; 131:104046. [PMID: 37207092 PMCID: PMC7614547 DOI: 10.1016/j.ppnp.2023.104046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Cancer therapy with accelerated charged particles is one of the most valuable biomedical applications of nuclear physics. The technology has vastly evolved in the past 50 years, the number of clinical centers is exponentially growing, and recent clinical results support the physics and radiobiology rationale that particles should be less toxic and more effective than conventional X-rays for many cancer patients. Charged particles are also the most mature technology for clinical translation of ultra-high dose rate (FLASH) radiotherapy. However, the fraction of patients treated with accelerated particles is still very small and the therapy is only applied to a few solid cancer indications. The growth of particle therapy strongly depends on technological innovations aiming to make the therapy cheaper, more conformal and faster. The most promising solutions to reach these goals are superconductive magnets to build compact accelerators; gantryless beam delivery; online image-guidance and adaptive therapy with the support of machine learning algorithms; and high-intensity accelerators coupled to online imaging. Large international collaborations are needed to hasten the clinical translation of the research results.
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Affiliation(s)
- Christian Graeff
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Planckstraße 1, 64291 Darmstadt, Germany
- Technische Universität Darmstadt, Darmstadt, Germany
| | - Lennart Volz
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Planckstraße 1, 64291 Darmstadt, Germany
| | - Marco Durante
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Planckstraße 1, 64291 Darmstadt, Germany
- Technische Universität Darmstadt, Darmstadt, Germany
- Dipartimento di Fisica “Ettore Pancini”, University Federico II, Naples, Italy
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Zhang Y, Trnkova P, Toshito T, Heijmen B, Richter C, Aznar M, Albertini F, Bolsi A, Daartz J, Bertholet J, Knopf A. A survey of practice patterns for real-time intrafractional motion-management in particle therapy. Phys Imaging Radiat Oncol 2023; 26:100439. [PMID: 37124167 PMCID: PMC10133874 DOI: 10.1016/j.phro.2023.100439] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/02/2023] Open
Abstract
Background and purpose Organ motion compromises accurate particle therapy delivery. This study reports on the practice patterns for real-time intrafractional motion-management in particle therapy to evaluate current clinical practice and wishes and barriers to implementation. Materials and methods An institutional questionnaire was distributed to particle therapy centres worldwide (7/2020-6/2021) asking which type(s) of real-time respiratory motion management (RRMM) methods were used, for which treatment sites, and what were the wishes and barriers to implementation. This was followed by a three-round DELPHI consensus analysis (10/2022) to define recommendations on required actions and future vision. With 70 responses from 17 countries, response rate was 100% for Europe (23/23 centres), 96% for Japan (22/23) and 53% for USA (20/38). Results Of the 68 clinically operational centres, 85% used RRMM, with 41% using both rescanning and active methods. Sixty-four percent used active-RRMM for at least one treatment site, mostly with gating guided by an external marker. Forty-eight percent of active-RRMM users wished to expand or change their RRMM technique. The main barriers were technical limitations and limited resources. From the DELPHI analysis, optimisation of rescanning parameters, improvement of motion models, and pre-treatment 4D evaluation were unanimously considered clinically important future focus. 4D dose calculation was identified as the top requirement for future commercial treatment planning software. Conclusion A majority of particle therapy centres have implemented RRMM. Still, further development and clinical integration were desired by most centres. Joint industry, clinical and research efforts are needed to translate innovation into efficient workflows for broad-scale implementation.
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Affiliation(s)
- Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Petra Trnkova
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Toshiyuki Toshito
- Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Ben Heijmen
- Department of Radiotherapy, Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands
| | - Christian Richter
- 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
| | - Marianne Aznar
- Faculty of Biology, Medicine and Health, Division of Cancer Sciences, University of Manchester, United Kingdom
| | | | - Alexandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Juliane Daartz
- F. Burr Proton Therapy, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Jenny Bertholet
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Antje Knopf
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Institute for Medical Engineering and Medical Informatics, School of Life Science FHNW, Muttenz, Switzerland
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Li G. Advances and potential of optical surface imaging in radiotherapy. Phys Med Biol 2022; 67:10.1088/1361-6560/ac838f. [PMID: 35868290 PMCID: PMC10958463 DOI: 10.1088/1361-6560/ac838f] [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: 12/08/2021] [Accepted: 07/22/2022] [Indexed: 11/12/2022]
Abstract
This article reviews the recent advancements and future potential of optical surface imaging (OSI) in clinical applications as a four-dimensional (4D) imaging modality for surface-guided radiotherapy (SGRT), including OSI systems, clinical SGRT applications, and OSI-based clinical research. The OSI is a non-ionizing radiation imaging modality, offering real-time 3D surface imaging with a large field of view (FOV), suitable for in-room interactive patient setup, and real-time motion monitoring at any couch rotation during radiotherapy. So far, most clinical SGRT applications have focused on treating superficial breast cancer or deep-seated brain cancer in rigid anatomy, because the skin surface can serve as tumor surrogates in these two clinical scenarios, and the procedures for breast treatments in free-breathing (FB) or at deep-inspiration breath-hold (DIBH), and for cranial stereotactic radiosurgery (SRS) and radiotherapy (SRT) are well developed. When using the skin surface as a body-position surrogate, SGRT promises to replace the traditional tattoo/laser-based setup. However, this requires new SGRT procedures for all anatomical sites and new workflows from treatment simulation to delivery. SGRT studies in other anatomical sites have shown slightly higher accuracy and better performance than a tattoo/laser-based setup. In addition, radiographical image-guided radiotherapy (IGRT) is still necessary, especially for stereotactic body radiotherapy (SBRT). To go beyond the external body surface and infer an internal tumor motion, recent studies have shown the clinical potential of OSI-based spirometry to measure dynamic tidal volume as a tumor motion surrogate, and Cherenkov surface imaging to guide and assess treatment delivery. As OSI provides complete datasets of body position, deformation, and motion, it offers an opportunity to replace fiducial-based optical tracking systems. After all, SGRT has great potential for further clinical applications. In this review, OSI technology, applications, and potential are discussed since its first introduction to radiotherapy in 2005, including technical characterization, different commercial systems, and major clinical applications, including conventional SGRT on top of tattoo/laser-based alignment and new SGRT techniques attempting to replace tattoo/laser-based setup. The clinical research for OSI-based tumor tracking is reviewed, including OSI-based spirometry and OSI-guided tumor tracking models. Ongoing clinical research has created more SGRT opportunities for clinical applications beyond the current scope.
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Affiliation(s)
- Guang Li
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States of America
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10
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Kang HK, Kim H, Hong CS, Kim J, Kim JS, Kim DW. Development and Performance Evaluation of Wearable Respiratory Self-Training System Using Patch Type Magnetic Sensor. Front Oncol 2021; 11:680147. [PMID: 34414107 PMCID: PMC8370089 DOI: 10.3389/fonc.2021.680147] [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: 03/13/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Respiratory training system that can be used by patients themselves was developed with a micro-electro-mechanical-system (MEMS)-based patch-type magnetic sensor. We conducted a basic function test and clinical usability evaluation to determine the system’s clinical applicability. Methods The system is designed with a sensor attached to the patient’s chest and a magnet on the back to monitor the patient’s respiration by measuring changes in magnetic intensity related to respiratory movements of the thoracic surface. The system comprises a MEMS-based patch-type magnetic sensor capable of wireless communication and being applied to measurement magnets and mobile applications. System performance was evaluated by the level of systemic noise, the precision of the sensor in various breathing patterns, how measurement signals change for varying distances, or the presence or absence of material between the sensor and the magnet. Various breathing patterns were created using the QUASAR respiratory motion phantom; the data obtained were analyzed using the fitting and peak value analysis methods. Results The sensor had a noise ratio of <0.54% of the signal; the average errors in signal amplitude and period for breathing patterns were 78.87 um and 72 ms, respectively. The signal could be measured consistently when the sensor–magnet distance was 10–25 cm. The signal difference was 1.89% for the presence or absence of a material, indicating that its influence on the measurement signal is relatively small. Conclusion The potential of our MEMS-based patch-type wearable respiratory self-training system was confirmed via basic function tests and clinical usability evaluations. We believe that the training system could provide thorough respiratory training for patients after a clinical trial with actual patients confirming its clinical efficacy and usability.
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Affiliation(s)
- Hyo Kyeong Kang
- Department of Integrative Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Hojin Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jihun Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Sung Kim
- Department of Integrative Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Wook Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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11
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Fattori G, Lomax AJ, Weber DC, Safai S. Technical assessment of the NDI Polaris Vega optical tracking system. Radiat Oncol 2021; 16:87. [PMID: 33980248 PMCID: PMC8114517 DOI: 10.1186/s13014-021-01804-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/07/2021] [Indexed: 12/02/2022] Open
Abstract
The Polaris product line from Northern Digital Inc. is well known for accurate optical tracking measurements in research and medical environments. The Spectra position sensor, to date often found in image guided radiotherapy suites, has however reached its end-of-life, being replaced by the new Vega model. The performance in static and dynamic measurements of this new device has been assessed in controlled laboratory conditions, against the strict requirements for system integration in radiation therapy. The system accuracy has improved with respect to the Spectra in both static (0.045 mm RMSE) and dynamic (0.09 mm IQR, < 20 cm/s) tracking and brings marginal improvement in the measurement latency (14.2 ± 1.8 ms). The system performance was further confirmed under clinical settings with the report of early results from periodic QA tests within specifications. Based on our tests, the Polaris Vega meets the quality standards of radiotherapy applications and can be safely used for monitoring respiratory breathing motion or verifying patient positioning.
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Affiliation(s)
- Giovanni Fattori
- Center for Proton Therapy, Paul Scherrer Institute, Forschungsstrasse 111, 5232, Villigen, Switzerland
| | - Antony John Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Forschungsstrasse 111, 5232, Villigen, Switzerland. .,Department of Physics, ETH Zurich, 8092, Zurich, Switzerland.
| | - Damien Charles Weber
- Center for Proton Therapy, Paul Scherrer Institute, Forschungsstrasse 111, 5232, Villigen, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, 8091, Zurich, Switzerland.,Department of Radiation Oncology, University Hospital Bern, 3000, Bern, Switzerland
| | - Sairos Safai
- Center for Proton Therapy, Paul Scherrer Institute, Forschungsstrasse 111, 5232, Villigen, Switzerland
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12
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Gut P, Krieger M, Lomax T, Weber DC, Hrbacek J. Combining rescanning and gating for a time-efficient treatment of mobile tumors using pencil beam scanning proton therapy. Radiother Oncol 2021; 160:82-89. [PMID: 33839206 DOI: 10.1016/j.radonc.2021.03.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/04/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Respiratory motion during proton therapy can severely degrade dose distributions, particularly due to interplay effects when using pencil beam scanning. Combined rescanning and gating treatments for moving tumors mitigates dose degradation, but at the cost of increased treatment delivery time. The objective of this study was to identify the time efficiency of these dose degradation-motion mitigation strategies for different range of motions. MATERIALS AND METHODS Seventeen patients with thoracic or abdominal tumors were studied. Tumor motion amplitudes ranged from 2-30 mm. Deliveries using different combinations of rescanning and gating were simulated with a dense dose spot grid (4 × 4 × 2.5 mm3) for all patients and a sparse dose spot grid (8 × 8 × 5 mm3) for six patients with larger tumor movements (>8 mm). The resulting plans were evaluated in terms of CTV coverage and time efficiency. RESULTS Based on the studied patient cohort, it has been shown that for amplitudes up to 5 mm, no motion mitigation is required with a dense spot grid. For amplitudes between 5 and 10 mm, volumetric rescanning should be applied while maintaining a 100% duty cycle when using a dense spot grid. Although gating could be envisaged to reduce the target volume for intermediate motion, it has been shown that the dose to normal tissues would only be reduced marginally. Moreover, the treatment time would increase. Finally, for larger motion amplitudes, both volumetric rescanning and respiratory gating should be applied with both spot grids. In addition, it has been shown that a dense spot grid delivers better CTV dose coverage than a sparse dose grid. CONCLUSION Volumetric rescanning and/or respiratory gating can be used in order to effectively and efficiently mitigate dose degradation due to tumor movement.
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Affiliation(s)
- Pauline Gut
- Department of Physics, ETH Zurich, Zurich, Switzerland; Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen PSI, Switzerland
| | - Miriam Krieger
- Department of Physics, ETH Zurich, Zurich, Switzerland; Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen PSI, Switzerland
| | - Tony Lomax
- Department of Physics, ETH Zurich, Zurich, Switzerland; Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen PSI, Switzerland
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen PSI, Switzerland; Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jan Hrbacek
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen PSI, Switzerland.
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13
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Speleers B, Schoepen M, Belosi F, Vakaet V, De Neve W, Deseyne P, Paelinck L, Vercauteren T, Parkes MJ, Lomax T, Van Greveling A, Bolsi A, Weber DC, Veldeman L, De Gersem W. Effects of deep inspiration breath hold on prone photon or proton irradiation of breast and regional lymph nodes. Sci Rep 2021; 11:6085. [PMID: 33727599 PMCID: PMC7966795 DOI: 10.1038/s41598-021-85401-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/23/2021] [Indexed: 12/14/2022] Open
Abstract
We report on a comparative dosimetrical study between deep inspiration breath hold (DIBH) and shallow breathing (SB) in prone crawl position for photon and proton radiotherapy of whole breast (WB) and locoregional lymph node regions, including the internal mammary chain (LN_MI). We investigate the dosimetrical effects of DIBH in prone crawl position on organs-at-risk for both photon and proton plans. For each modality, we further estimate the effects of lung and heart doses on the mortality risks of different risk profiles of patients. Thirty-one patients with invasive carcinoma of the left breast and pathologically confirmed positive lymph node status were included in this study. DIBH significantly decreased dose to heart for photon and proton radiotherapy. DIBH also decreased lung doses for photons, while increased lung doses were observed using protons because the retracting heart is displaced by low-density lung tissue. For other organs-at-risk, DIBH resulted in significant dose reductions using photons while minor differences in dose deposition between DIBH and SB were observed using protons. In patients with high risks for cardiac and lung cancer mortality, average thirty-year mortality rates from radiotherapy-related cardiac injury and lung cancer were estimated at 3.12% (photon DIBH), 4.03% (photon SB), 1.80% (proton DIBH) and 1.66% (proton SB). The radiation-related mortality risk could not outweigh the ~ 8% disease-specific survival benefit of WB + LN_MI radiotherapy in any of the assessed treatments.
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Affiliation(s)
- Bruno Speleers
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Max Schoepen
- Department of Industrial Systems Engineering and Product Design, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | | | - Vincent Vakaet
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Wilfried De Neve
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Pieter Deseyne
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Leen Paelinck
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Tom Vercauteren
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Michael J Parkes
- Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Tony Lomax
- Paul Scherrer Institut, Villigen, Switzerland
| | | | | | - Damien C Weber
- Paul Scherrer Institut, Villigen, Switzerland
- Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland
- Radiation Oncology Department, University Hospital of Zurich, Zurich, Switzerland
| | - Liv Veldeman
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Werner De Gersem
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
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