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SHIRATO H. Biomedical advances and future prospects of high-precision three-dimensional radiotherapy and four-dimensional radiotherapy. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2023; 99:389-426. [PMID: 37821390 PMCID: PMC10749389 DOI: 10.2183/pjab.99.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Biomedical advances of external-beam radiotherapy (EBRT) with improvements in physical accuracy are reviewed. High-precision (±1 mm) three-dimensional radiotherapy (3DRT) can utilize respective therapeutic open doors in the tumor control probability curve and in the normal tissue complication probability curve instead of the one single therapeutic window in two-dimensional EBRT. High-precision 3DRT achieved higher tumor control and probable survival rates for patients with small peripheral lung and liver cancers. Four-dimensional radiotherapy (4DRT), which can reduce uncertainties in 3DRT due to organ motion by real-time (every 0.1-1 s) tumor-tracking and immediate (0.1-1 s) irradiation, have achieved reduced adverse effects for prostate and pancreatic tumors near the digestive tract and with similar or better tumor control. Particle beam therapy improved tumor control and probable survival for patients with large liver tumors. The clinical outcomes of locally advanced or multiple tumors located near serial-type organs can theoretically be improved further by integrating the 4DRT concept with particle beams.
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Affiliation(s)
- Hiroki SHIRATO
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Yamaba Y, Yoshihara M, Takakuwa O, Iwata H, Ogino H, Sakane T, Haneda H, Nakao M, Yamada K, Inoue Y, Kunii E, Akita K. Factors related to fixedness after transbronchial fiducial marker placement for image-guided proton therapy: A retrospective study. Respir Investig 2023; 61:636-642. [PMID: 37478530 DOI: 10.1016/j.resinv.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND The usefulness of transbronchially inserted gold fiducial markers has been reported in radiation therapy and proton therapy for mobile lesions, such as lung tumors. However, there is occasional dropout of inserted markers. This retrospective study investigated the factors related to dropout of markers inserted for image-guided proton therapy (IGPT). METHODS Between June 2013 and October 2021, 535 markers were inserted in 171 patients with lung tumors. We investigated whether marker dropout was affected by the location of marker insertion, distance between the marker and the chest wall (DMC), and difference in forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC). Marker dropout from the time of planning computed tomography (CT) to follow-up CT was also evaluated. RESULTS Of the 535 inserted markers, 417 were confirmed on planning CT and 356 on follow-up CT after IGPT. Multivariate analysis revealed that marker insertion into the upper lobe and FEV1/FVC ≥70% were factors associated with total marker dropout. Marker dropout between planning CT and follow-up CT was associated with DMC, FEV1/FVC ≥70%, and planning CT performed within 4 days of marker insertion. CONCLUSIONS Marker dropout can be minimized by inserting markers more peripherally, by considering the planned insertion location, and FEV1/FVC. Additionally, planning CT should be scheduled at least 5 days after marker insertion.
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Affiliation(s)
- Yusuke Yamaba
- Department of Respiratory Medicine, Thoracic Oncology Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
| | - Misuzu Yoshihara
- Department of Respiratory Medicine, Thoracic Oncology Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
| | - Osamu Takakuwa
- Department of Medical Education, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
| | - Tadashi Sakane
- Department of Thoracic Surgery, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
| | - Hiroshi Haneda
- Department of Thoracic Surgery, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
| | - Makoto Nakao
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 396 Minamihonndenn, Maegasu-cho, Yatomi City, Aichi Prefecture 498-8502, Japan
| | - Kazuki Yamada
- Department of Respiratory Medicine, Thoracic Oncology Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
| | - Yoshitsugu Inoue
- Department of Respiratory Medicine, Thoracic Oncology Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
| | - Eiji Kunii
- Department of Respiratory Medicine, Thoracic Oncology Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
| | - Kenji Akita
- Department of Respiratory Medicine, Thoracic Oncology Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan
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Yasue K, Fuse H, Oyama S, Hanada K, Shinoda K, Ikoma H, Fujisaki T, Tamaki Y. Quantitative analysis of the intra-beam respiratory motion with baseline drift for respiratory-gating lung stereotactic body radiation therapy. JOURNAL OF RADIATION RESEARCH 2022; 63:137-147. [PMID: 34718704 PMCID: PMC8776700 DOI: 10.1093/jrr/rrab098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/03/2021] [Indexed: 06/13/2023]
Abstract
This study aimed to quantitatively clarify the baseline drift for each respiratory cycle in two respiratory-gating methods using the intra-beam respiratory motion data of lung cancer patients. The residual motion and dose distribution were calculated based on intra-beam respiratory motion data with the baseline drift. To quantify the baseline drift $\Delta$ during irradiation, it was defined as the inclination between the detected expiration point and the expiration point in the next cycle in the anterior-posterior (AP), cranial-caudal (CC) and left-right (LR) directions obtained using an in-house programme. The baseline drift value reached up to 0.74 mm/s in the CC direction as per the respiratory motion data of 10 patients. The homogeneity index (HI) of the phase-gating method tended to increase because the target was irradiated even when the amplitude position of the target differed from period to period. In contrast, the amplitude-gating method enabled irradiation considering the amplitude position of the target because the gating window was set considering the amplitude position of the respiratory motion. The respiratory-gating methods and respiratory phase in respiratory-gating lung stereotactic body radiation therapy (SBRT) must be determined based on the respiratory motion of the patients.
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Affiliation(s)
- Kenji Yasue
- Corresponding author. Graduate School of Health Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2, Ami, Ami, Inashiki, Ibaraki, 300-0394, Japan. Tel.: +81-29-888-2218; Fax: +81-29-888-2318;
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Erdoğan T, Fidan U, Özyiğit G. Patient-specific tumor and respiratory monitoring phantom design for quality controls of stereotactic ablative body radiotherapy in lung cancer cases. Phys Med 2021; 90:40-49. [PMID: 34536726 DOI: 10.1016/j.ejmp.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022] Open
Abstract
The design, production and adaptability to clinical routine of a patient-specific tumor and respiratory monitoring phantom (TRMP) was investigated using 3D printer technology. TRMP and GTV modelling were done using 4D-CT images of the inhalation phase. The model was converted to STL (Stereolithography) format and printed with STH (Strong Herbal) biopolymer with HU (Hounsfield Unit) suitable for imaging purposes. The assembly of TRMP motorized parts and mechanical equipment has been completed and made suitable for clinical use. In the first part of the study, the deviations of radio-opaque markers attached to the TRMP sternum to perform mechanical quality control tests and T1-7 costal vertebrae in CC, AP, and LAT directions were evaluated. In the second part of the study, in order to evaluate the usability of the TRMP in quality assurance (QA), point dose measurements with BeO OSL dosimetry and EBT3 gafchromic film measurements were taken in Trilogy® radiotherapy accelerator and CyberKnife® robotic radiosurgery accelerator. In this study, we present a highly flexible TMRP capable of performing independent internal and external motions. TRMP was successfully tested in different treatment accelerators, both mechanically and dosimetrically.
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Affiliation(s)
- Taha Erdoğan
- Department of Radiation Oncology, Afyonkarahisar Health Sciences University Faculty of Medicine, 03030 Afyonkarahisar, Turkey.
| | - Uğur Fidan
- Department of Biomedical Engineering, Afyonkocatepe University Faculty of Engineering, 03030 Afyonkarahisar, Turkey
| | - Gökhan Özyiğit
- Department of Radiation Oncology, Cancer Institute, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
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Bednarz BP, Jupitz S, Lee W, Mills D, Chan H, Fiorillo T, Sabitini J, Shoudy D, Patel A, Mitra J, Sarcar S, Wang B, Shepard A, Matrosic C, Holmes J, Culberson W, Bassetti M, Hill P, McMillan A, Zagzebski J, Smith LS, Foo TK. First-in-human imaging using a MR-compatible e4D ultrasound probe for motion management of radiotherapy. Phys Med 2021; 88:104-110. [PMID: 34218199 DOI: 10.1016/j.ejmp.2021.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 06/08/2021] [Accepted: 06/21/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Respiration-induced tumor or organ positional changes can impact the accuracy of external beam radiotherapy. Motion management strategies are used to account for these changes during treatment. The authors report on the development, testing, and first-in-human evaluation of an electronic 4D (e4D) MR-compatible ultrasound probe that was designed for hands-free operation in a MR and linear accelerator (LINAC) environment. METHODS Ultrasound components were evaluated for MR compatibility. Electromagnetic interference (EMI) shielding was used to enclose the entire probe and a factory-fabricated cable shielded with copper braids was integrated into the probe. A series of simultaneous ultrasound and MR scans were acquired and analyzed in five healthy volunteers. RESULTS The ultrasound probe led to minor susceptibility artifacts in the MR images immediately proximal to the ultrasound probe at a depth of <10 mm. Ultrasound and MR-based motion traces that were derived by tracking the salient motion of endogenous target structures in the superior-inferior (SI) direction demonstrated good concordance (Pearson correlation coefficients of 0.95-0.98) between the ultrasound and MRI datasets. CONCLUSION We have demonstrated that our hands-free, e4D probe can acquire ultrasound images during a MR acquisition at frame rates of approximately 4 frames per second (fps) without impacting either the MR or ultrasound image quality. This use of this technology for interventional procedures (e.g. biopsies and drug delivery) and motion compensation during imaging are also being explored.
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Affiliation(s)
- Bryan P Bednarz
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States.
| | - Sydney Jupitz
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Warren Lee
- GE Global Research, Niskayuna, NY 12309, United States
| | - David Mills
- GE Global Research, Niskayuna, NY 12309, United States
| | - Heather Chan
- GE Global Research, Niskayuna, NY 12309, United States
| | | | | | - David Shoudy
- GE Global Research, Niskayuna, NY 12309, United States
| | - Aqsa Patel
- GE Global Research, Niskayuna, NY 12309, United States
| | - Jhimli Mitra
- GE Global Research, Niskayuna, NY 12309, United States
| | | | - Bo Wang
- GE Global Research, Niskayuna, NY 12309, United States
| | - Andrew Shepard
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States; Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, United States
| | - Charles Matrosic
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, United States
| | - James Holmes
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Wesley Culberson
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Michael Bassetti
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Patrick Hill
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Alan McMillan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - James Zagzebski
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - L Scott Smith
- GE Global Research, Niskayuna, NY 12309, United States
| | - Thomas K Foo
- GE Global Research, Niskayuna, NY 12309, United States
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de Bruin K, Dahele M, Mostafavi H, Slotman BJ, Verbakel WF. Markerless Real-Time 3-Dimensional kV Tracking of Lung Tumors During Free Breathing Stereotactic Radiation Therapy. Adv Radiat Oncol 2021; 6:100705. [PMID: 34113742 PMCID: PMC8170355 DOI: 10.1016/j.adro.2021.100705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/04/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Accurate verification of tumor position during irradiation could reduce the probability of target miss. We investigated whether a commercial gantry-mounted 2-dimensional (2D) kilo-voltage (kV) imaging system could be used for real-time 3D tumor tracking during volumetric modulated arc therapy (VMAT) lung stereotactic body radiation therapy (SBRT). Markerless tumor tracking on kV fluoroscopic images was validated using a life-like moving thorax phantom and subsequently performed on kV images continuously acquired before and during free-breathing VMAT lung SBRT. Methods and Materials The 3D-printed/molded phantom containing 3 lung tumors was moved in 3D in TrueBeam developer mode, using simulated regular/irregular breathing patterns. Planar kV images were acquired at 7 frames/s during 11 Gy/fraction 10 MV flattening filter free VMAT. 2D reference templates were created for each gantry angle using the planning 4D computed tomography inspiration phase. kV images and templates were matched using normalized cross correlation to determine 2D tumor position, and triangulation of 2D matched projections determined the third dimension. 3D target tracking performed on cone beam computed tomography projection data from 18 patients (20 tumors) and real-time online tracking data from 2 of the 18 patients who underwent free-breathing VMAT lung SBRT are presented. Results For target 1 and 2 of the phantom (upper lung and middle/medial lung, mean density –130 Hounsfield units), 3D results within 2 mm of the known position were present in 92% and 96% of the kV projections, respectively. For target 3 (inferior lung, mean density –478 Hounsfield units) this dropped to 80%. Benchmarking against the respiratory signal, 13/20 (65%) tumors (10.5 ± 11.1 cm3) were considered successfully tracked on the cone beam computed tomography data. Tracking was less successful (≤50% of the time) in 7/20 (1.2 ± 1.5 cm3). Successful online tracking during lung SBRT was demonstrated. Conclusions 3D markerless tumor tracking on a standard linear accelerator using template matching and triangulation of free-breathing kV fluoroscopic images was possible in 65% of small lung tumors. The smallest tumors were most challenging.
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Affiliation(s)
- Kimmie de Bruin
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Berend J. Slotman
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Wilko F.A.R. Verbakel
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Corresponding author: Wilko F.A.R. Verbakel, PhD, PDEng
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Dellmann MFW, Jerg KI, Stratemeier J, Heiman R, Hesser JW, Aschenbrenner KP, Blessing M. Noise-robust breathing-phase estimation on marker-free, ultra low dose X-ray projections for real-time tumor localization via surrogate structures. Z Med Phys 2021; 31:355-364. [PMID: 34088565 DOI: 10.1016/j.zemedi.2021.04.001] [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: 02/10/2020] [Revised: 11/11/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This paper presents a novel strategy for feature-based breathing-phase estimation on ultra low-dose X-ray projections for tumor motion control in radiation therapy. METHODS Coarse-scaled Curvelet coefficients are identified as motion sensitive but noise-robust features for this purpose. For feature-based breathing-phase estimation, an ensemble strategy with two classifiers is used. This consensus-based estimation substantially increases tracking reliability by rejection of false positives. The algorithm is evaluated on both synthetic and measured phantom data: Monte Carlo simulated ultra low dose projections for a C-arm X-ray and on the basis of 4D-chest-CTs of eight patients on one hand side and real measurements based on a motion phantom. RESULTS To achieve an accuracy of breathing-phase estimation of more than 95% a fluence between 20 and 400 photons per pixel (open field) is required depending on the patient. Furthermore, the algorithm is evaluated on real ultra low dose projections from an XVI R5.0 system (Elekta AB, Stockholm, Sweden) using an additional lead filter to reduce fluence. The classifiers-consensus-based-gating method estimated the correct position of the test projections in all test cases at a fluence of ∼180 photons per pixel and 92% at a fluence of ∼40 photons per pixel. The deposited dose to patient per image is in the range of nGy. CONCLUSIONS A novel method is presented for estimation of breathing-phases for real-time tumor localization at ultra low dose both on a simulation and a phantom basis. Its accuracy is comparable to state of the art X-ray based algorithms while the released dose to patients is reduced by two to three orders of magnitude compared to conventional template-based approaches. This allows for continuous motion control during irradiation without the need of external markers.
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Affiliation(s)
- Max F W Dellmann
- Department of Data Analysis and Modeling in Medicine, Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medical Faculty of Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Katharina I Jerg
- Department of Data Analysis and Modeling in Medicine, Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medical Faculty of Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Johanna Stratemeier
- Department of Data Analysis and Modeling in Medicine, Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medical Faculty of Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Ron Heiman
- Department of Data Analysis and Modeling in Medicine, Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medical Faculty of Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Jürgen W Hesser
- Department of Data Analysis and Modeling in Medicine, Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medical Faculty of Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Im Neuenheimer Feld 205, 69120 Heidelberg, Germany; Central Institute for Computer Engineering (ZITI), Heidelberg University, Im Neuenheimer Feld 368, 69120 Heidelberg, Germany
| | - Katharina P Aschenbrenner
- Department of Data Analysis and Modeling in Medicine, Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medical Faculty of Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Im Neuenheimer Feld 205, 69120 Heidelberg, Germany
| | - Manuel Blessing
- Department of Data Analysis and Modeling in Medicine, Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medical Faculty of Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Keikhai Farzaneh MJ, Momennezhad M, Naseri S. Gated Radiotherapy Development and its Expansion. J Biomed Phys Eng 2021; 11:239-256. [PMID: 33937130 PMCID: PMC8064130 DOI: 10.31661/jbpe.v0i0.948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/14/2018] [Indexed: 12/25/2022]
Abstract
One of the most important challenges in treatment of patients with cancerous tumors of chest and abdominal areas is organ movement. The delivery of treatment radiation doses to tumor tissue is a challenging matter while protecting healthy and radio sensitive tissues. Since the movement of organs due to respiration causes a discrepancy in the middle of planned and delivered dose distributions. The moderation in the fatalistic effect of intra-fractional target travel on the radiation therapy correctness is necessary for cutting-edge methods of motion remote monitoring and cancerous growth irradiancy. Tracking respiratory milling and implementation of breath-hold techniques by respiratory gating systems have been used for compensation of respiratory motion negative effects. Therefore, these systems help us to deliver precise treatments and also protect healthy and critical organs. It seems aspiration should be kept under observation all over treatment period employing tracking seed markers (e.g. fiducials), skin surface scanners (e.g. camera and laser monitoring systems) and aspiration detectors (e.g. spirometers). However, these systems are not readily available for most radiotherapy centers around the word. It is believed that providing and expanding the required equipment, gated radiotherapy will be a routine technique for treatment of chest and abdominal tumors in all clinical radiotherapy centers in the world by considering benefits of respiratory gating techniques in increasing efficiency of patient treatment in the near future. This review explains the different technologies and systems as well as some strategies available for motion management in radiotherapy centers.
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Affiliation(s)
- Mohammad Javad Keikhai Farzaneh
- PhD, Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- PhD, Department of Medical Physics, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehdi Momennezhad
- PhD, Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- PhD, Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shahrokh Naseri
- PhD, Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- PhD, Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Evaluation of thoracic surface motion during the free breathing and deep inspiration breath hold methods. Med Dosim 2021; 46:274-278. [PMID: 33766492 DOI: 10.1016/j.meddos.2021.02.006] [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: 07/21/2020] [Revised: 01/29/2021] [Accepted: 02/10/2021] [Indexed: 11/23/2022]
Abstract
The aim of this study was to evaluate thoracic surface motion from chest wall expansion during free breathing (FB) and deep inspiration breath hold (DIBH) methods, measured with and without 4-dimensional computed tomography (4D-CT) simulation, using equipment developed in-house. The respiratory amplitude and chest wall expansion were evaluated at 5 levels of the thorax, (the sterno-clavicular joint (SCJ), the second level, the intermammary line (IML), the fourth level and the caudal end of the xiphoid process (XP)) using radiopaque wires and potentiometers, with a CT scan simultaneously. This study included 25 examinees (10 volunteers performed FB, 10 volunteers performed DIBH and 5 patients performed FB). For low and irregular respiration, coaching was used, and its impact was evaluated for both breathing methods, FB and DIBH. The breathing amplitude performed with FB between volunteers and patients was not detectable at the SCJ; increasing to the abdomen, 3 mm vs 2 mm (p = 0.326) at the second level; 6 mm vs 4 mm (p = 0.042) at the IML; 10 mm vs 8 mm (p < 0.01) at the fourth level; and 23 mm vs 19 mm (p < 0.001) at the XP. Contrary to the DIBH, where breathing amplitude was greater at 2 first levels 18 mm (SCJ) and 20 mm (second level), decreasing to the abdomen, 14 mm (IML); 11 mm (fourth level); and 10 mm (XP). Chest wall expansion was not detected at the SCJ, while at other levels measured from 1 to 7 mm. Coaching was improve breathing amplitude, for both methods, FB (3 mm) and DIBH (5 mm). The location of amplification is different depending on the breathing method and the in-house phantom was useful to check the amplification level.
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Kim J, Keum KC, Lee H, Hong CS, Park K, Kim JS. Image quality of 4D in-treatment CBCT acquired during lung SBRT using FFF beam: a phantom study. Radiat Oncol 2020; 15:224. [PMID: 32977808 PMCID: PMC7519557 DOI: 10.1186/s13014-020-01668-3] [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: 05/08/2020] [Accepted: 09/14/2020] [Indexed: 12/25/2022] Open
Abstract
Background Rotational beam delivery enables concurrent acquisition of cone-beam CT (CBCT), thereby facilitating further geometric verification of patient setup during radiation treatment. However, it is challenging to acquire CBCT during stereotactic body radiation therapy (SBRT) using flattening-filter free X-ray beams, in which a high radiation dose is delivered. This study presents quantitative evaluation results of the image quality in four-dimensional (4D) in-treatment CBCT acquired during SBRT delivery. Methods The impact of megavoltage (MV) scatter and acquisition parameters on the image quality was evaluated using Catphan 503 and XSight lung tracking phantoms. The in-treatment CBCT images of the phantoms were acquired while delivering 16 SBRT plans. The uniformity, contrast, and contrast-to-noise ratio (CNR) of the in-treatment CBCT images were calculated and compared to those of CBCT images acquired without SBRT delivery. Furthermore, the localizing accuracy of the moving target in the XSight lung phantom was evaluated for 10 respiratory phases. Results The CNR of the 3D-reconstucted Catphan CBCT images was reduced from 6.3 to 2.6 due to the effect of MV treatment scatter. Both for the Catphan and XSight phantoms, the CBCT image quality was affected by the tube current and monitor units (MUs) of the treatment plan. The lung target in the XSight tracking phantom was most visible for extreme phases; the mean CNRs of the lung target in the in-treatment CBCT images (with 40 mA tube current) across the SBRT plans were 3.2 for the end-of-exhalation phase and 3.0 for the end-of-inhalation phase. The lung target was localized with sub-millimeter accuracy for the extreme respiratory phases. Conclusions Full-arc acquisition with an increased tube current (e.g. 40 mA) is recommended to compensate for degradation in the CBCT image quality due to unflattened MV beam scatter. Acquiring in-treatment CBCT with a high-MU treatment beam is also suggested to improve the resulting CBCT image quality.
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Affiliation(s)
- Jihun Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Ho Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Kwangwoo Park
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea.
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11
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Sonier M, Vangenderen B, Visagie D, Appeldoorn C, Chiang T(A, Mathew L, Reinsberg S, Rose J, Ramaseshan R. Commissioning a four‐dimensional Computed Tomography Simulator for minimum target size due to motion in the Anterior–Posterior direction: a procedure and treatment planning recommendations. J Appl Clin Med Phys 2020; 21:116-123. [PMID: 32667132 PMCID: PMC7497911 DOI: 10.1002/acm2.12980] [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: 03/27/2020] [Revised: 04/14/2020] [Accepted: 06/21/2020] [Indexed: 11/21/2022] Open
Abstract
The purpose of this work is to develop a procedure for commissioning four‐dimensional computed tomography (4DCT) algorithms for minimum target reconstruction size, to quantify the effect of anterior–posterior (AP) motion artifacts on known object reconstruction for periodic and irregular breathing patterns, and to provide treatment planning recommendations for target sizes below a minimum threshold. A mechanical platform enabled AP motion of a rod and lung phantom during 4DCT acquisition. Static, artifact‐free scans of the phantoms were first acquired. AP sinusoidal and patient breathing motion was applied to obtain 4DCT images. 4DCT reconstruction artifacts were assessed by measuring the apparent width and angle of the rod. Comparison of known tumor diameters and volumes between the static image parameters with the 4DCT image sets was used to quantify the extent of AP reconstruction artifact and contour deformation. Examination of the rod width, under sinusoidal motion, found it was best represented during the inhale and exhale phases for all periods and ranges of motion. From the gradient phases, the apparent width of the rod decreased with increasing amplitude and decreasing period. The rod angle appeared larger on the reconstructed images due to the presence of motion artifact. The apparent diameters of the spherical tumors on the gradient phases were larger/equivalent than the true values in the AP/LR direction, respectively, while the exhale phase consistently displayed the spheres at the approximately correct diameter. The Eclipse calculated diameter matched closely with the true diameter on the exhale phase and was found to be larger on the inhale, MIP, and Avg scans. The procedure detailed here may be used during the acceptance and commissioning period of a computed tomography simulator or retroactively when implementing a SBRT program to determine the minimum target size that can be reliably reconstructed.
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Affiliation(s)
- Marcus Sonier
- Department of Medical Physics BC Cancer –Abbotsford Centre Abbotsford BC Canada
- Department of Physics University of British Columbia Vancouver BC Canada
| | - Brandon Vangenderen
- Department of Medical Physics BC Cancer –Abbotsford Centre Abbotsford BC Canada
| | - Dallas Visagie
- Department of Medical Physics BC Cancer –Abbotsford Centre Abbotsford BC Canada
| | - Cameron Appeldoorn
- Department of Medical Physics BC Cancer –Abbotsford Centre Abbotsford BC Canada
| | | | - Lindsay Mathew
- Department of Medical Physics BC Cancer –Abbotsford Centre Abbotsford BC Canada
| | - Stefan Reinsberg
- Department of Physics University of British Columbia Vancouver BC Canada
| | - Jim Rose
- Department of Medical Physics BC Cancer –Abbotsford Centre Abbotsford BC Canada
| | - Ramani Ramaseshan
- Department of Medical Physics BC Cancer –Abbotsford Centre Abbotsford BC Canada
- Department of Physics University of British Columbia Vancouver BC Canada
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12
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Watkins WT, Nourzadeh H, Siebers JV. Dose escalation in the definite target volume. Med Phys 2020; 47:3174-3183. [PMID: 32267535 PMCID: PMC8259326 DOI: 10.1002/mp.14164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To introduce the definite target volume (DTV) and evaluate dosimetric consequences of boosting dose to this region of high clinical target volume (CTV)- and low organs at risk (OAR)-probability. METHODS This work defines the DTV via occupancy probability and via contraction of the CTV by margin M less any planning risk volume (PRV) volumes. The equivalence to within varying occupancy probability of the two methods is established for spherical target volumes. We estimate a margin for four radiation treatment sites based on modern images guided radiation therapy-literature utilizing repeat volumetric imaging. Based on margins and patient-specific DTV targets, the ability to dose escalate the DTV including the effects of spatial uncertainty was evaluated. We simulate delivery assuming violation of the underlying spatial uncertainty of 130%. RESULTS Contracting the planning target volume (PTV) by M and excluding PRV volumes, the DTV ranged from 7.3 to 93.6 cc. In a brain treatment, DTV-Dmax increased to 66.8 Gy (145% of prescription isodose); in advanced lung DTV-Dmax increased to 122.2 Gy (204% of prescription isodose), in a pancreatic case DTV-Dmax was boosted up to 87.3 Gy (173% or prescription isodose), and in retroperitoneal sarcoma to 74.6 Gy (249% of prescription isodose). The high point doses were not associated with increased dose to OARs, even when considering the effects of spatial uncertainty. Simulated delivery at 130% of assumed spatial uncertainties revealed DTV-based planning can result in minor increases in OAR Dmean/Dmax of 2.7 ± 2.1 Gy/1.8 ± 2.2 Gy with duodenum Dmax > 110% of prescription isodose in the pancreatic case. These dose increases were consistent with simulation of clinical, homogenous PTV-dose distributions. CONCLUSION We have proposed and tested a method to deliver extremely high doses to subvolumes of target volumes in multiple treatment sites by defining a new target volume, the DTV. Based on simulated delivery, the method does not result in significant increases in dose to OARs if spatial uncertainty can be estimated.
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Affiliation(s)
- W. Tyler Watkins
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA 22908, USA
| | - Hamidreza Nourzadeh
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA 22908, USA
| | - Jeffrey V. Siebers
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA 22908, USA
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13
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Vinod SK, Hau E. Radiotherapy treatment for lung cancer: Current status and future directions. Respirology 2020; 25 Suppl 2:61-71. [PMID: 32516852 DOI: 10.1111/resp.13870] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 02/27/2020] [Accepted: 05/17/2020] [Indexed: 12/23/2022]
Abstract
Radiotherapy is an important modality used for the treatment of lung cancer. Seventy-seven percent of all patients with lung cancer have an evidence-based indication for radiotherapy, although it is often underutilized. Radiotherapy can be used as curative or palliative treatment across all stages of disease. Technological advances have allowed better radiotherapy targeting of tumours and reduced incidental irradiation of surrounding normal tissues. This has expanded the indications for radiotherapy in lung cancer and improved outcomes both in terms of increasing survival and reducing toxicity. This review examines the current role of radiotherapy in lung cancer, discusses the evidence behind this and identifies future directions in the radiotherapy treatment of lung cancer.
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Affiliation(s)
- Shalini K Vinod
- Cancer Therapy Centre, Liverpool Hospital, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of NSW, Sydney, NSW, Australia
| | - Eric Hau
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia.,Blacktown Haematology and Oncology Cancer Care Centre, Blacktown Hospital, Blacktown, NSW, Australia.,Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
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14
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Mueller M, Zolfaghari R, Briggs A, Furtado H, Booth J, Keall P, Nguyen D, O'Brien R, Shieh CC. The first prospective implementation of markerless lung target tracking in an experimental quality assurance procedure on a standard linear accelerator. Phys Med Biol 2020; 65:025008. [PMID: 31783395 DOI: 10.1088/1361-6560/ab5d8b] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The ability to track tumour motion without implanted markers on a standard linear accelerator (linac) could enable wide access to real-time adaptive radiotherapy for cancer patients. We previously have retrospectively validated a method for 3D markerless target tracking using intra-fractional kilovoltage (kV) projections acquired on a standard linac. This paper presents the first prospective implementation of markerless lung target tracking on a standard linac and its quality assurance (QA) procedure. The workflow and the algorithm developed to track the 3D target position during volumetric modulated arc therapy treatment delivery were optimised. The linac was operated in clinical QA mode, while kV projections were streamed to a dedicated computer using a frame-grabber software. The markerless target tracking accuracy and precision were measured in a lung phantom experiment under the following conditions: static localisation of seven distinct positions, dynamic localisation of five patient-measured motion traces, and dynamic localisation with treatment interruption. The QA guidelines were developed following the AAPM Task Group 147 report with the requirement that the tracking margin components, the margins required to account for tracking errors, did not exceed 5 mm in any direction. The mean tracking error ranged from 0.0 to 0.9 mm (left-right), -0.6 to -0.1 mm (superior-inferior) and -0.7 to 0.1 mm (anterior-posterior) over the three tests. Larger errors were found in cases with large left-right or anterior-posterior and small superior-inferior motion. The tracking margin components did not exceed 5 mm in any direction and ranged from 0.4 to 3.2 mm (left-right), 0.7 to 1.6 mm (superior-inferior) and 0.8 to 1.5 mm (anterior-posterior). This study presents the first prospective implementation of markerless lung target tracking on a standard linac and provides a QA procedure for its safe clinical implementation, potentially enabling real-time adaptive radiotherapy for a large population of lung cancer patients.
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Affiliation(s)
- Marco Mueller
- ACRF Image X Institute, The University of Sydney, Sydney, NSW, Australia. Author to whom any correspondence should be addressed
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15
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Muramatsu S. [Method for Spectral Analysis of the Respiratory Cycle Based on Dynamic Pulmonary Computed Tomography]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2020; 76:1017-1024. [PMID: 33087647 DOI: 10.6009/jjrt.2020_jsrt_76.10.1017] [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: 06/11/2023]
Abstract
Dynamic pulmonary computed tomography (CT) enables morphological analyses of tumor adhesion and infiltration and functional analyses of the lungs based on four-dimensional data. However, the functional analysis requires visualization of the respiratory cycle. The aim of the present study was to investigate the utility of spectral analysis as part of the functional analysis of the lungs based on dynamic pulmonary CT. In this study, the reference curves for the respiratory cycle were obtained using measurements of all phases of respiration based on the movement of the diaphragm. The reference curves and fields of the unaffected lung were divided into three sections: upper, middle, and lower. The central position within each lung field in the axial section was used as the fixed location, and the lung field concentrations (CT values within each lung field) were measured. Using the maximum entropy (ME) method, the spectral analysis was performed for the lung field concentration curves obtained in this manner. The investigated items were the peak frequency in the power spectrum based on the ME analysis of the reference curve and the time difference from this peak frequency in the upper, middle, and lower lung field concentration curves. The time differences (median±standard deviation) from the reference values were 0.18±0.20, 0.34±0.33, and 0.34±0.35 s in the upper, middle, and lower lung fields, respectively, indicating the smallest time difference in the upper lung field. Performing spectral analysis using the ME method on lung field concentration curves enables assessment of the respiratory cycle based on dynamic pulmonary CT, and this approach is consistent with the visual assessment of the respiratory cycle.
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16
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Hypofractionated 192Ir source stereotactic ablative brachytherapy with coplanar template assistance in the primary treatment of peripheral lung cancer. J Contemp Brachytherapy 2019; 11:370-378. [PMID: 31523239 PMCID: PMC6737569 DOI: 10.5114/jcb.2019.87218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/23/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose In this study, we reported the safety and efficacy of hypofractionated 192Ir source stereotactic ablative brachytherapy (SABT) with coplanar template assistance for peripheral lung cancer, and compared the dosimetric parameters between SABT and stereotactic body radiotherapy (SBRT). Material and methods Thirty-three peripheral lung cancer patients, with the gross lung tumor volume (GTVL) < 5 cm in diameter were enrolled in this study. We assessed the safety and efficacy of SABT, and compared the dosimetric parameters between SABT and SBRT. Results Chest computed tomography (CT) of post-SABT revealed mild pneumothorax in 2 of 33 patients. Complete response (CR) plus partial response (PR) rate for GTVL at 6-month was 100%. Local control (LC) rate for GTVL at 1-year was 96.9%. For organs at risk (OARs), D1000 cm3, and D1500 cm3 for lung in 1, 3, and 5 fractions were not statistically different between SABT and SBRT (all p > 0.05); the remaining dosimetric parameters were significantly lower in SABT than in SBRT (all p < 0.01). Conclusions SABT can provide safe and effective treatment, and warrant generalization for peripheral lung cancer.
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17
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Chaudhary RK, Kumar R, Sharma SD, Bera S, Mittal V, Deshpande S. Performance Validation of In-House Developed Four-dimensional Dynamic Phantom. J Med Phys 2019; 44:99-105. [PMID: 31359927 PMCID: PMC6580812 DOI: 10.4103/jmp.jmp_114_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: The objective of this study was to validate the performance characteristics of in-house developed four-dimensional (4D) dynamic phantom (FDDP). Materials and Methods: There are three target inserts of 1.0, 1.5 and 2.0 cm diameter. The targets were driven in sinusoidal pattern in the longitudinal direction, using the combinations of amplitudes of 0.5, 1.0, and 1.5 cm with frequencies of 0.2 and 0.25 Hz. The amplitude and frequency of motion were measured manually, and by using Real-Time Position Management (RPM) system also. The static, free-breathing, and 4D computed tomography (CT) scans of the phantom were acquired with 1.0 mm slice thickness. The 4DCT scans were sorted into 0%–90% phase, and the maximum intensity projection (MIP) images were also generated. The static, free-breathing, and 4DCT data sets and MIP images were contoured to get VStatic, VFB, V00......V90, and internal target volume ITV MIP, respectively. The individual phase volumes were summed to obtain V4D. The length of the target in the motion was measured using MIP image and compared with theoretical length (TL). The variation of 3D displacement vector of individual phase volume with respect to V00 with the phase of motion was studied at amplitude and frequency of 1.0 cm and 0.25 Hz, respectively. The degree of similarity between VFB and V4D and VFB and ITVMIP was also studied for all the target sizes at amplitude and frequency of 1.0 cm and 0.2 Hz and 1.0 cm and 0.25 Hz, respectively. Results: The amplitude and frequency of motion agreed within the limits of uncertainty with the manually and RPM measured values. The length of target in the motion matched within 1.0 mm with TL. The 3D displacement of individual phase volume showed no target size dependence, and the degree of similarity between VFB and V4D and VFB and ITVMIP decreases with increase in the displacement between the two volumes. Conclusions: The mechanical and imaging performances of FDDP were found within the acceptable limits. Therefore, this phantom can be used for quality assurance of 4D imaging process in radiotherapy.
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Affiliation(s)
- Rahul Kumar Chaudhary
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Rajesh Kumar
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - S D Sharma
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Anushakti Nagar, Mumbai, Maharashtra, India
| | - Soumen Bera
- P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Vikram Mittal
- P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Sudesh Deshpande
- P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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18
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Using Cine-Averaged CT With the Shallow Breathing Pattern to Reduce Respiration-Induced Artifacts for Thoracic Cavity PET/CT Scans. AJR Am J Roentgenol 2019; 213:140-146. [DOI: 10.2214/ajr.18.20606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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19
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Utilisation de la scanographie quadridimensionnelle : principaux aspects techniques et intérêts cliniques. Cancer Radiother 2019; 23:334-341. [DOI: 10.1016/j.canrad.2018.07.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 11/22/2022]
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20
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Ranjbar M, Sabouri P, Repetto C, Sawant A. A novel deformable lung phantom with programably variable external and internal correlation. Med Phys 2019; 46:1995-2005. [PMID: 30919974 DOI: 10.1002/mp.13507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Lung motion phantoms used to validate radiotherapy motion management strategies have fairly simplistic designs that do not adequately capture complex phenomena observed in human respiration such as external and internal deformation, variable hysteresis and variable correlation between different parts of the thoracic anatomy. These limitations make reliable evaluation of sophisticated motion management techniques quite challenging. In this work, we present the design and implementation of a programmable, externally and internally deformable lung motion phantom that allows for a reproducible change in external-internal and internal-internal correlation of embedded markers. METHODS An in-house-designed lung module, made from natural latex foam was inserted inside the outer shell of a commercially available lung phantom (RSD, Long Beach, CA, USA). Radiopaque markers were placed on the external surface and embedded into the lung module. Two independently programmable high-precision linear motion actuators were used to generate primarily anterior-posterior (AP) and primarily superior-inferior (SI) motion in a reproducible fashion in order to enable (a) variable correlation between the displacement of interior volume and the exterior surface, (b) independent changes in the amplitude of the AP and SI motions, and (c) variable hysteresis. The ability of the phantom to produce complex and variable motion accurately and reproducibly was evaluated by programming the two actuators with mathematical and patient-recorded lung tumor motion traces, and recording the trajectories of various markers using kV fluoroscopy. As an example application, the phantom was used to evaluate the performance of lung motion models constructed from kV fluoroscopy and 4DCT images. RESULTS The phantom exhibited a high degree of reproducibility and marker motion ranges were reproducible to within 0.5 mm. Variable correlation was observed between the displacements of internal-internal and internal-external markers. The SI and AP components of motion of a specific marker had a correlation parameter that varied from -11 to 17. Monitoring a region of interest on the phantom's surface to estimate internal marker motion led to considerably lower uncertainties than when a single point was monitored. CONCLUSIONS We successfully designed and implemented a programmable, externally and internally deformable lung motion phantom that allows for a reproducible change in external-internal and internal-internal correlation of embedded markers.
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Affiliation(s)
- Maida Ranjbar
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Pouya Sabouri
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Carlo Repetto
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Amit Sawant
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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21
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Kanzaki R, Araki F, Kawamura S. Image-guidance technique comparison on respiratory reproducibility and dose indexes for stereotactic body radiotherapy in lung tumor. Med Dosim 2019; 44:385-393. [PMID: 30857654 DOI: 10.1016/j.meddos.2019.02.003] [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: 07/30/2018] [Revised: 01/19/2019] [Accepted: 02/13/2019] [Indexed: 11/17/2022]
Abstract
We investigated respiratory reproducibility from position errors of gold internal fiducial markers for breath-hold (BH) and real-time tumor tracking (RTT) techniques for stereotactic body radiotherapy in lung tumors. The relationship between position errors and dose indexes was checked for both techniques. The stereotactic body radiotherapy plan in lung tumors was planned for 29 patients. The tumor positioning was arranged using 1.5 mm diameter gold internal fiducial markers. First, CT images were acquired to analyze position errors of gold markers for BH and RTT techniques. The offset plans for both techniques were calculated by displacing the mean position errors. The dose indexes (D98, D95, D2, mean dose) in a planning target volume were evaluated from dose volume histograms for the original plan, BH, and RTT offset plans. The relationship between position errors and dose indexes was analyzed using the root mean square (RMS) for both techniques. For the BH, the RMS was 3.29 mm at the lower lobe. Similarly, it was 1.34 mm for the RTT. The difference for D98 by position error for BH was -7.0 ± 10.8% at the lower lobe and the difference of all dose indexes for the RTT was less than 1%. The D2 and mean dose for both techniques were nearly the same as those of the original plan. In conclusion, the adaptation of the BH technique should be ≤2 mm RMS. If the position error is >2 mm RMS, the RTT technique should be used instead of the BH technique.
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Affiliation(s)
- Ryuji Kanzaki
- Department of Radiological Technology, Yamaguchi University Hospital, Ube City, Yamaguchi, Japan; Graduate School of Health Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Fujio Araki
- Department of Health Sciences, Faculty of Life Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan.
| | - Shinji Kawamura
- Graduate School of Health Sciences, Teikyo University, Omuta, Fukuoka, Japan
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Molitoris JK, Diwanji T, Snider JW, Mossahebi S, Samanta S, Badiyan SN, Simone CB, Mohindra P. Advances in the use of motion management and image guidance in radiation therapy treatment for lung cancer. J Thorac Dis 2018; 10:S2437-S2450. [PMID: 30206490 PMCID: PMC6123191 DOI: 10.21037/jtd.2018.01.155] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 01/26/2018] [Indexed: 12/22/2022]
Abstract
The development of advanced radiation technologies, including intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and proton therapy, has resulted in increasingly conformal radiation treatments. Recent evidence for the importance of minimizing dose to normal critical structures including the heart and lungs has led to incorporation of these advanced treatment modalities into radiation therapy (RT) for non-small cell lung cancer (NSCLC). While such technologies have allowed for improved dose delivery, implementation requires improved target accuracy with treatments, placing increasing importance on evaluating tumor motion at the time of planning and verifying tumor position at the time of treatment. In this review article, we describe issues and updates related both to motion management and image guidance in the treatment of NSCLC.
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Affiliation(s)
- Jason K. Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tejan Diwanji
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James W. Snider
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Radiation Oncology, Maryland Proton Treatment Center, University of Maryland, Baltimore, MD, USA
| | - Sina Mossahebi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Radiation Oncology, Maryland Proton Treatment Center, University of Maryland, Baltimore, MD, USA
| | - Santanu Samanta
- Department of Radiation Oncology, Maryland Proton Treatment Center, University of Maryland, Baltimore, MD, USA
| | - Shahed N. Badiyan
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Radiation Oncology, Maryland Proton Treatment Center, University of Maryland, Baltimore, MD, USA
| | - Charles B. Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Radiation Oncology, Maryland Proton Treatment Center, University of Maryland, Baltimore, MD, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Radiation Oncology, Maryland Proton Treatment Center, University of Maryland, Baltimore, MD, USA
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Quiñones DR, Soler-Egea D, González-Pérez V, Reibke J, Simarro-Mondejar E, Pérez-Feito R, García-Manrique JA, Crispín V, Moratal D. Open Source 3D Printed Lung Tumor Movement Simulator for Radiotherapy Quality Assurance. MATERIALS 2018; 11:ma11081317. [PMID: 30061503 PMCID: PMC6117797 DOI: 10.3390/ma11081317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/19/2018] [Accepted: 07/26/2018] [Indexed: 12/11/2022]
Abstract
In OECD (Organization for Economic Co-operation and Development) countries, cancer is one of the main causes of death, lung cancer being one of the most aggressive. There are several techniques for the treatment of lung cancer, among which radiotherapy is one of the most effective and least invasive for the patient. However, it has associated difficulties due to the moving target tumor. It is possible to reduce the side effects of radiotherapy by effectively tracking a tumor and reducing target irradiation margins. This paper presents a custom electromechanical system that follows the movement of a lung tumor. For this purpose, a hysteresis loop of human lung movement during breathing was studied to obtain its characteristic movement equation. The system is controlled by an Arduino, steppers motors and a customized 3D printed mechanism to follow the characteristic human breathing, obtaining an accurate trajectory. The developed device helps the verification of individualized radiation treatment plans and permits the improvement of radiotherapy quality assurance procedures.
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Affiliation(s)
- Darío R Quiñones
- Centre for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain.
| | - David Soler-Egea
- Centre for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain.
| | - Víctor González-Pérez
- Department of Radiophysics, Fundación Instituto Valenciano de Oncología, 46009 Valencia, Spain.
| | - Johanna Reibke
- Centre for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain.
| | - Elena Simarro-Mondejar
- Centre for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain.
| | - Ricardo Pérez-Feito
- Thermodynamics Department, Universitat Politècnica de València, 46022 Valencia, Spain.
| | - Juan A García-Manrique
- Institute of Design for Manufacturing and Automated Production, Universitat Politècnica de València, 46022 Valencia, Spain.
| | - Vicente Crispín
- Department of Radiophysics, Fundación Instituto Valenciano de Oncología, 46009 Valencia, Spain.
| | - David Moratal
- Centre for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain.
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Borm KJ, Oechsner M, Wiegandt M, Hofmeister A, Combs SE, Duma MN. Moving targets in 4D-CTs versus MIP and AIP: comparison of patients data to phantom data. BMC Cancer 2018; 18:760. [PMID: 30041618 PMCID: PMC6056919 DOI: 10.1186/s12885-018-4647-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/28/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose Maximum (MIP) and average intensity projection (AIP) CTs allow rapid definition of internal target volumes in a 4D-CT. The purpose of this study was to assess the accuracy of these techniques in a large patient cohort in combination with simulations on a lung phantom. Methods 4DCT data from a self-developed 3D lung phantom and from 50 patients with lung tumors were analyzed. ITVs were contoured in maximum (ITVMIP) and average intensity projection (ITVAIP) and subsequently compared to ITVs contoured in 10 phases of a 4D-CT (ITV10). In the phantom study additionally a theoretical target volume was calculated for each motion and compared to the contoured volumes. Results ITV10 overestimated the actual target volume by 9.5% whereas ITVMIP and ITVAIP lead to an underestimation of − 1.8% and − 11.4% in the phantom study. The ITVMIP (ITVAIP) was in average − 10.0% (− 18.7%) smaller compared to the ITV10. In the patient CTs deviations between ITV10 and MIP/AIP were significantly larger (MIP: – 20.2% AIP: -33.7%) compared to this. Tumors adjacent to the chestwall, the mediastinum or the diaphragm showed lower conformity between ITV10 and ITVMIP (ITVAIP) compared to tumors solely surrounded by lung tissue. Large tumor diameters (> 3.5 cm) and large motion amplitudes (> 1 cm) were associated with lower conformity between intensity projection CTs and ITV10−. Conclusion The application of MIP and AIP in the clinical practice should not be a standard procedure for every patient, since relevant underestimation of tumor volumes may occur. This is especially true if the tumor borders the mediastinum, the chest wall or the diaphragm and if tumors show a large motion amplitude.
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Affiliation(s)
- Kai Joachim Borm
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Moritz Wiegandt
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Medical School Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas Hofmeister
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Medical School Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
| | - Marciana Nona Duma
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, Munich, Germany. .,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany.
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Kashani R, Olsen JR. Magnetic Resonance Imaging for Target Delineation and Daily Treatment Modification. Semin Radiat Oncol 2018; 28:178-184. [DOI: 10.1016/j.semradonc.2018.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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26
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Xie K, Sun H, Lin T, Gao L, Sui J, Ni X. IMRT dose verification considering passing rate and respiratory motion. Oncol Lett 2018; 16:963-969. [PMID: 29963170 PMCID: PMC6019885 DOI: 10.3892/ol.2018.8724] [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: 06/29/2017] [Accepted: 03/28/2018] [Indexed: 12/02/2022] Open
Abstract
The aim of the present study was to investigate the association between the dynamic intensity-modulated radiation therapy planned γ analysis passing rate and respiratory amplitude (A) and period (T) for different tumor volumes. A total of 30 patients with malignant lung tumors were divided into three groups: A; B; and C. The average tumor volumes (V) in the A, B and C groups were 635, 402 and 213 cm3, respectively. The simulated A values were set at 0, 5, 10, 15, 20 and 25 mm. The T values were set at 4, 5 and 6 sec. The γ analysis passing rate was calculated under different conditions (dose difference, 3%; distance difference, 3 mm). Compared with the γ analysis passing rate in the A group (A=0, static; T=4, 5, 6 sec), the γ analysis passing rate deviation (A=5 mm) was <3.3%. However, this difference was not statistically significant (P>0.05). With a gradual increase in A value, the passing rate decreased. The deviation between the 3 groups was <2.5% at the same A value (T=4, 5 and 6 sec). A descending trend of passing rate with increased A value was revealed. At the same A and T values, the passing rate decreased with decreased tumor volume. At the same tumor volume, the passing rate decreased when the A value increased. The respiratory cycle was not demonstrated to be associated with the passing rate. Overall, these results suggest that the A value should be controlled in clinical radiotherapy.
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Affiliation(s)
- Kai Xie
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, Jiangsu 213003, P.R. China
| | - Hongfei Sun
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, Jiangsu 213003, P.R. China
| | - Tao Lin
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, Jiangsu 213003, P.R. China
| | - Liugang Gao
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, Jiangsu 213003, P.R. China
| | - Jianfeng Sui
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, Jiangsu 213003, P.R. China
| | - Xinye Ni
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, Jiangsu 213003, P.R. China
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Hazelaar C, Dahele M, Mostafavi H, van der Weide L, Slotman B, Verbakel W. Markerless positional verification using template matching and triangulation of kV images acquired during irradiation for lung tumors treated in breath-hold. ACTA ACUST UNITED AC 2018; 63:115005. [DOI: 10.1088/1361-6560/aac1a9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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28
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Shahzadeh S, Gholami S, Aghamiri SMR, Mahani H, Nabavi M, Kalantari F. Evaluation of normal lung tissue complication probability in gated and conventional radiotherapy using the 4D XCAT digital phantom. Comput Biol Med 2018; 97:21-29. [PMID: 29684782 DOI: 10.1016/j.compbiomed.2018.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 04/10/2018] [Accepted: 04/10/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE The present study was conducted to investigate normal lung tissue complication probability in gated and conventional radiotherapy (RT) as a function of diaphragm motion, lesion size, and its location using 4D-XCAT digital phantom in a simulation study. MATERIALS AND METHODS Different time series of 3D-CT images were generated using the 4D-XCAT digital phantom. The binary data obtained from this phantom were then converted to the digital imaging and communication in medicine (DICOM) format using an in-house MATLAB-based program to be compatible with our treatment planning system (TPS). The 3D-TPS with superposition computational algorithm was used to generate conventional and gated plans. Treatment plans were generated for 36 different XCAT phantom configurations. These included four diaphragm motions of 20, 25, 30 and 35 mm, three lesion sizes of 3, 4, and 5 cm in diameter and each tumor was placed in four different lung locations (right lower lobe, right upper lobe, left lower lobe and left upper lobe). The complication of normal lung tissue was assessed in terms of mean lung dose (MLD), the lung volume receiving ≥20 Gy (V20), and normal tissue complication probability (NTCP). RESULTS The results showed that the gated RT yields superior outcomes in terms of normal tissue complication compared to the conventional RT. For all cases, the gated radiation therapy technique reduced the mean dose, V20, and NTCP of lung tissue by up to 5.53 Gy, 13.38%, and 23.89%, respectively. CONCLUSIONS The results of this study showed that the gated RT provides significant advantages in terms of the normal lung tissue complication, compared to the conventional RT, especially for the lesions near the diaphragm.
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Affiliation(s)
- Sara Shahzadeh
- Department of Medical Radiation Engineering, Shahid Beheshti University, Tehran, Iran
| | - Somayeh Gholami
- Radiotherapy Oncology Research Centre, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Hojjat Mahani
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Science, Tehran, Iran; Radiation Application Research School, Nuclear Science and Technology Research Institute, Tehran, Iran
| | - Mansoure Nabavi
- Radiotherapy Oncology Research Centre, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Faraz Kalantari
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA
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29
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Dose Verification for Tumor Motion with Different Treatment Planning Systems: A Dynamic Thorax Phantom Study. J Med Biol Eng 2018. [DOI: 10.1007/s40846-017-0367-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Molitoris JK, Diwanji T, Snider JW, Mossahebi S, Samanta S, Onyeuku N, Mohindra P, Choi JI, Simone CB. Optimizing immobilization, margins, and imaging for lung stereotactic body radiation therapy. Transl Lung Cancer Res 2018; 8:24-31. [PMID: 30788232 DOI: 10.21037/tlcr.2018.09.25] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The simultaneous advancement of technologies for the delivery of precisely targeted radiation therapy and the paradigm shift to substantial hypofractionation have led to significant improvements in the treatment of early stage non-small cell lung cancer (ES-NSCLC). Stereotactic body radiation therapy (SBRT) has become a well-established option for the treatment of ES-NSCLC and is now becoming widely available within the radiation oncology community. Implementation of this technique, however, requires highly accurate target delineation, thorough evaluation of tumor motion, and improved on-board imaging at the time of treatment for patient alignment, each of which is critical for successful tumor control and mitigation of risks to normal tissues. In this article, we review updates and issues related to immobilization and image guidance for SBRT in the treatment of ES-NSCLC.
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Affiliation(s)
- Jason K Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tejan Diwanji
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - James W Snider
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sina Mossahebi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Santanu Samanta
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Nasarachi Onyeuku
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - J Isabelle Choi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
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31
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Menten MJ, Wetscherek A, Fast MF. MRI-guided lung SBRT: Present and future developments. Phys Med 2017; 44:139-149. [PMID: 28242140 DOI: 10.1016/j.ejmp.2017.02.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/25/2017] [Accepted: 02/07/2017] [Indexed: 12/25/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) is rapidly becoming an alternative to surgery for the treatment of early-stage non-small cell lung cancer patients. Lung SBRT is administered in a hypo-fractionated, conformal manner, delivering high doses to the target. To avoid normal-tissue toxicity, it is crucial to limit the exposure of nearby healthy organs-at-risk (OAR). Current image-guided radiotherapy strategies for lung SBRT are mostly based on X-ray imaging modalities. Although still in its infancy, magnetic resonance imaging (MRI) guidance for lung SBRT is not exposure-limited and MRI promises to improve crucial soft-tissue contrast. Looking beyond anatomical imaging, functional MRI is expected to inform treatment decisions and adaptations in the future. This review summarises and discusses how MRI could be advantageous to the different links of the radiotherapy treatment chain for lung SBRT: diagnosis and staging, tumour and OAR delineation, treatment planning, and inter- or intrafractional motion management. Special emphasis is placed on a new generation of hybrid MRI treatment devices and their potential for real-time adaptive radiotherapy.
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Affiliation(s)
- Martin J Menten
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
| | - Andreas Wetscherek
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Martin F Fast
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
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Ono T, Miyabe Y, Takahashi K, Akimoto M, Mukumoto N, Ishihara Y, Nakamura M, Mizowaki T, Hiraoka M. Geometric and dosimetric accuracy of dynamic tumor tracking during volumetric-modulated arc therapy using a gimbal mounted linac. Radiother Oncol 2017; 129:166-172. [PMID: 29137808 DOI: 10.1016/j.radonc.2017.10.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim was to examine the feasibility of a dynamic tumor-tracking volumetric modulated arc therapy (DTT-VMAT) technique using a gimbal-mounted linac and assess its positional, mechanical and dosimetric accuracy. MATERIALS AND METHODS DTT-VMAT was performed using a surrogated signal-based technique. The positional tracking accuracy was evaluated as the difference between the predicted and detected target positions for various wave patterns. Mechanical accuracy measurements included gantry, multileaf collimator (MLC) and gimbal positions. The differences between the command and the measured positions were evaluated for various wave patterns. Dosimetric verification was performed using Gafchromic EBT3 films in the benchmark phantom and two clinical cases. RESULTS The root mean square error (RMSE) of the positional accuracy was within 0.31 mm. The RMSE of mechanical accuracy was within 0.14° for the gantry, 0.11 ± 0.02 mm for the MLC and 0.13 mm for the gimbal positions. The passing rate of the 3%/3 mm gamma index was greater than 83.3% and 91.2% for the benchmark phantom and two clinical cases, respectively. CONCLUSIONS The positional, mechanical and dosimetric accuracy of DTT-VMAT were evaluated. DTT-VMAT with a gimbal-mounted linac had sufficient accuracy and presents a new strategy for treatment of several tumors with respiratory motion.
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Affiliation(s)
- Tomohiro Ono
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan; Department of Radiation Oncology, Wakayama Red Cross Hospital, Japan
| | - Yuki Miyabe
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan.
| | - Kunio Takahashi
- Advanced Mechanical Systems Department, Mitsubishi Heavy Industries Ltd, Hiroshima, Japan
| | - Mami Akimoto
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan
| | - Nobutaka Mukumoto
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan
| | - Yoshitomo Ishihara
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan
| | - Masahiro Hiraoka
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan; Department of Radiation Oncology, Wakayama Red Cross Hospital, Japan
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33
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Xu Z, Yao R, Podgorsak MB, Wang IZ. Effects of collimator angle, couch angle, and starting phase on motion-tracking dynamic conformal arc therapy (4D DCAT). J Appl Clin Med Phys 2017; 18:54-63. [PMID: 28730652 PMCID: PMC5874990 DOI: 10.1002/acm2.12132] [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] [Received: 11/22/2016] [Revised: 05/17/2017] [Accepted: 05/22/2017] [Indexed: 11/07/2022] Open
Abstract
Purpose The aim of this study was to find an optimized configuration of collimator angle, couch angle, and starting tracking phase to improve the delivery performance in terms of MLC position errors, maximal MLC leaf speed, and total beam‐on time of DCAT plans with motion tracking (4D DCAT). Method and materials Nontracking conformal arc plans were first created based on a single phase (maximal exhalation phase) of a respiratory motion phantom with a spherical target. An ideal model was used to simulate the target motion in superior‐inferior (SI), anterior‐posterior (AP), and left‐right (LR) dimensions. The motion was decomposed to the MLC leaf position coordinates for motion compensation and generating 4D DCAT plans. The plans were studied with collimator angle ranged from 0° to 90°; couch angle ranged from 350°(−10°) to 10°; and starting tracking phases at maximal inhalation (θ=π/2) and exhalation (θ=0) phases. Plan performance score (PPS) evaluates the plan complexity including the variability in MLC leaf positions, degree of irregularity in field shape and area. PPS ranges from 0 to 1, where low PPS indicates a plan with high complexity. The 4D DCAT plans with the maximal and the minimal PPS were selected and delivered on a Varian TrueBeam linear accelerator. Gafchromic‐EBT3 dosimetry films were used to measure the dose delivered to the target in the phantom. Gamma analysis for film measurements with 90% passing rate threshold using 3%/3 mm criteria and trajectory log files were analyzed for plan delivery accuracy evaluation. Results The maximal PPS of all the plans was 0.554, achieved with collimator angle at 87°, couch angle at 350°, and starting phase at maximal inhalation (θ=π/2). The maximal MLC leaf speed, MLC leaf errors, total leaf travel distance, and beam‐on time were 20 mm/s, 0.39 ± 0.16 mm, 1385 cm, and 157 s, respectively. The starting phase, whether at maximal inhalation or exhalation had a relatively small contribution to PPS (0.01 ± 0.05). Conclusions By selecting collimator angle, couch angle, and starting tracking phase, 4D DCAT plans with the maximal PPS demonstrated less MLC leaf position errors, lower maximal MLC leaf speed, and shorter beam‐on time which improved the performance of 4D motion‐tracking DCAT delivery.
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Affiliation(s)
- Zhengzheng Xu
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Physiology and Biophysics, State University of New York at Buffalo, Buffalo, NY, USA
| | - Rutao Yao
- Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, NY, USA.,Department of Physiology and Biophysics, State University of New York at Buffalo, Buffalo, NY, USA
| | - Matthew B Podgorsak
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Physiology and Biophysics, State University of New York at Buffalo, Buffalo, NY, USA
| | - Iris Z Wang
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Physiology and Biophysics, State University of New York at Buffalo, Buffalo, NY, USA
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Wolfs CJA, Brás MG, Schyns LEJR, Nijsten SMJJG, van Elmpt W, Scheib SG, Baltes C, Podesta M, Verhaegen F. Detection of anatomical changes in lung cancer patients with 2D time-integrated, 2D time-resolved and 3D time-integrated portal dosimetry: a simulation study. Phys Med Biol 2017; 62:6044-6061. [PMID: 28582267 DOI: 10.1088/1361-6560/aa7730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aim of this work is to assess the performance of 2D time-integrated (2D-TI), 2D time-resolved (2D-TR) and 3D time-integrated (3D-TI) portal dosimetry in detecting dose discrepancies between the planned and (simulated) delivered dose caused by simulated changes in the anatomy of lung cancer patients. For six lung cancer patients, tumor shift, tumor regression and pleural effusion are simulated by modifying their CT images. Based on the modified CT images, time-integrated (TI) and time-resolved (TR) portal dose images (PDIs) are simulated and 3D-TI doses are calculated. The modified and original PDIs and 3D doses are compared by a gamma analysis with various gamma criteria. Furthermore, the difference in the D 95% (ΔD 95%) of the GTV is calculated and used as a gold standard. The correlation between the gamma fail rate and the ΔD 95% is investigated, as well the sensitivity and specificity of all combinations of portal dosimetry method, gamma criteria and gamma fail rate threshold. On the individual patient level, there is a correlation between the gamma fail rate and the ΔD 95%, which cannot be found at the group level. The sensitivity and specificity analysis showed that there is not one combination of portal dosimetry method, gamma criteria and gamma fail rate threshold that can detect all simulated anatomical changes. This work shows that it will be more beneficial to relate portal dosimetry and DVH analysis on the patient level, rather than trying to quantify a relationship for a group of patients. With regards to optimizing sensitivity and specificity, different combinations of portal dosimetry method, gamma criteria and gamma fail rate should be used to optimally detect certain types of anatomical changes.
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Affiliation(s)
- Cecile J A Wolfs
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
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Yoganathan SA, Maria Das KJ, Agarwal A, Kumar S. Magnitude, Impact, and Management of Respiration-induced Target Motion in Radiotherapy Treatment: A Comprehensive Review. J Med Phys 2017; 42:101-115. [PMID: 28974854 PMCID: PMC5618455 DOI: 10.4103/jmp.jmp_22_17] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/31/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022] Open
Abstract
Tumors in thoracic and upper abdomen regions such as lungs, liver, pancreas, esophagus, and breast move due to respiration. Respiration-induced motion introduces uncertainties in radiotherapy treatments of these sites and is regarded as a significant bottleneck in achieving highly conformal dose distributions. Recent developments in radiation therapy have resulted in (i) motion-encompassing, (ii) respiratory gating, and (iii) tracking methods for adapting the radiation beam aperture to account for the respiration-induced target motion. The purpose of this review is to discuss the magnitude, impact, and management of respiration-induced tumor motion.
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Affiliation(s)
- S. A. Yoganathan
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - K. J. Maria Das
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arpita Agarwal
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shaleen Kumar
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Feasibility of using single photon counting X-ray for lung tumor position estimation based on 4D-CT. Z Med Phys 2017; 27:243-254. [PMID: 28595774 DOI: 10.1016/j.zemedi.2017.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/04/2017] [Accepted: 05/12/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE In stereotactic body radiation therapy of lung tumors, reliable position estimation of the tumor is necessary in order to minimize normal tissue complication rate. While kV X-ray imaging is frequently used, continuous application during radiotherapy sessions is often not possible due to concerns about the additional dose. Thus, ultra low-dose (ULD) kV X-ray imaging based on a single photon counting detector is suggested. This paper addresses the lower limit of photons to locate the tumor reliably with an accuracy in the range of state-of-the-art methods, i.e. a few millimeters. METHOD 18 patient cases with four dimensional CT (4D-CT), which serves as a-priori information, are included in the study. ULD cone beam projections are simulated from the 4D-CTs including Poisson noise. The projections from the breathing phases which correspond to different tumor positions are compared to the ULD projection by means of Poisson log-likelihood (PML) and correlation coefficient (CC), and template matching under these metrics. RESULTS The results indicate that in full thorax imaging five photons per pixel suffice for a standard deviation in tumor positions of less than half a breathing phase. Around 50 photons per pixel are needed to achieve this accuracy with the field of view restricted to the tumor region. Compared to CC, PML tends to perform better for low photon counts and shifts in patient setup. Template matching only improves the position estimation in high photon counts. The quality of the reconstruction is independent of the projection angle. CONCLUSIONS The accuracy of the proposed ULD single photon counting system is in the range of a few millimeters and therefore comparable to state-of-the-art tumor tracking methods. At the same time, a reduction in photons per pixel by three to four orders of magnitude relative to commercial systems with flatpanel detectors can be achieved. This enables continuous kV image-based position estimation during all fractions since the additional dose to the patient is negligible.
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Ehrbar S, Jöhl A, Tartas A, Stark LS, Riesterer O, Klöck S, Guckenberger M, Tanadini-Lang S. ITV, mid-ventilation, gating or couch tracking - A comparison of respiratory motion-management techniques based on 4D dose calculations. Radiother Oncol 2017; 124:80-88. [PMID: 28587761 DOI: 10.1016/j.radonc.2017.05.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 04/19/2017] [Accepted: 05/20/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Respiratory motion-management techniques (MMT) aim to ensure tumor dose coverage while sparing lung tissue. Dynamic treatment-couch tracking of the moving tumor is a promising new MMT and was compared to the internal-target-volume (ITV) concept, the mid-ventilation (MidV) principle and the gating approach in a planning study based on 4D dose calculations. METHODS For twenty patients with lung lesions, planning target volumes (PTV) were adapted to the MMT and stereotactic body radiotherapy treatments were prepared with the 65%-isodose enclosing the PTV. For tracking, three concepts for target volume definition were considered: Including the gross tumor volume of one phase (single-phase tracking), including deformations between phases (multi-phase tracking) and additionally including tracking latencies of a couch tracking system (reliable couch tracking). The accumulated tumor and lung doses were estimated with 4D dose calculations based on 4D-CT datasets and deformable image registration. RESULTS Single-phase tracking showed the lowest ipsilateral lung Dmean (median: 3.3Gy), followed by multi-phase tracking, gating, reliable couch tracking, MidV and ITV concepts (3.6, 3.8, 4.1, 4.3 and 4.8Gy). The 4D dose calculations showed the MidV and single-phase tracking overestimated the target mean dose (-2.3% and -1.3%), while it was slightly underestimated by the other MMT (<+1%). CONCLUSION The ITV concept ensures tumor coverage, but exposes the lung tissue to a higher dose. The MidV, gating and tracking concepts were shown to reduce the lung dose. Neglecting non-translational changes of the tumor in the target volume definition for tracking results in a slightly reduced target coverage. The slightly inferior dose coverage for MidV should be considered when applying this technique clinically.
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Affiliation(s)
- Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland.
| | - Alexander Jöhl
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Switzerland
| | - Adrianna Tartas
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Warsaw, Faculty of Physics, Poland
| | - Luisa Sabrina Stark
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland
| | - Stephan Klöck
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland
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Katoh N, Soda I, Tamamura H, Takahashi S, Uchinami Y, Ishiyama H, Ota K, Inoue T, Onimaru R, Shibuya K, Hayakawa K, Shirato H. Clinical outcomes of stage I and IIA non-small cell lung cancer patients treated with stereotactic body radiotherapy using a real-time tumor-tracking radiotherapy system. Radiat Oncol 2017; 12:3. [PMID: 28057036 PMCID: PMC5217432 DOI: 10.1186/s13014-016-0742-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 12/08/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose To investigate the clinical outcomes of stage I and IIA non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiotherapy (SBRT) using a real-time tumor-tracking radiotherapy (RTRT) system. Materials and methods Patterns-of-care in SBRT using RTRT for histologically proven, peripherally located, stage I and IIA NSCLC was retrospectively investigated in four institutions by an identical clinical report format. Patterns-of-outcomes was also investigated in the same manner. Results From September 2000 to April 2012, 283 patients with 286 tumors were identified. The median age was 78 years (52–90) and the maximum tumor diameters were 9 to 65 mm with a median of 24 mm. The calculated biologically effective dose (10) at the isocenter using the linear-quadratic model was from 66 Gy to 126 Gy with a median of 106 Gy. With a median follow-up period of 28 months (range 0–127), the overall survival rate for the entire group, for stage IA, and for stage IB + IIA was 75%, 79%, and 65% at 2 years, and 64%, 70%, and 50% at 3 years, respectively. In the multivariate analysis, the favorable predictive factor was female for overall survival. There were no differences between the clinical outcomes at the four institutions. Grade 2, 3, 4, and 5 radiation pneumonitis was experienced by 29 (10.2%), 9 (3.2%), 0, and 0 patients. The subgroup analyses revealed that compared to margins from gross tumor volume (GTV) to planning target volume (PTV) ≥ 10 mm, margins < 10 mm did not worsen the overall survival and local control rates, while reducing the risk of radiation pneumonitis. Conclusions This multi-institutional retrospective study showed that the results were consistent with the recent patterns-of-care and patterns-of-outcome analysis of SBRT. A prospective study will be required to evaluate SBRT using a RTRT system with margins from GTV to PTV < 10mm. Electronic supplementary material The online version of this article (doi:10.1186/s13014-016-0742-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Norio Katoh
- Department of Radiation Oncology, Hokkaido University Hospital, North-14 West-5, Kita-ku, Sapporo, Japan. .,Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.
| | - Itaru Soda
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroyasu Tamamura
- Department of Nuclear Medicine, Fukui Prefectural Hospital, Fukui, Japan
| | - Shotaro Takahashi
- Department of Therapeutic Radiology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yusuke Uchinami
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiromichi Ishiyama
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kiyotaka Ota
- Department of Nuclear Medicine, Fukui Prefectural Hospital, Fukui, Japan
| | - Tetsuya Inoue
- Department of Radiation Oncology, Hokkaido University Hospital, North-14 West-5, Kita-ku, Sapporo, Japan
| | - Rikiya Onimaru
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Keiko Shibuya
- Department of Therapeutic Radiology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kazushige Hayakawa
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroki Shirato
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Bourque AE, Bedwani S, Filion É, Carrier JF. A particle filter based autocontouring algorithm for lung tumor tracking using dynamic magnetic resonance imaging. Med Phys 2016; 43:5161. [DOI: 10.1118/1.4961403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Baba F, Tanaka S, Nonogaki Y, Hasegawa S, Nishihashi M, Ayakawa S, Yamada M, Shibamoto Y. Effects of audio coaching and visual feedback on the stability of respiration during radiotherapy. Jpn J Radiol 2016; 34:572-8. [DOI: 10.1007/s11604-016-0560-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/30/2016] [Indexed: 01/25/2023]
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Yan H, Tian Z, Shao Y, Jiang SB, Jia X. A new scheme for real-time high-contrast imaging in lung cancer radiotherapy: a proof-of-concept study. Phys Med Biol 2016; 61:2372-88. [PMID: 26943271 PMCID: PMC5590640 DOI: 10.1088/0031-9155/61/6/2372] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Visualization of anatomy in real time is of critical importance for motion management in lung cancer radiotherapy. To achieve real-time, and high-contrast in-treatment imaging, we propose a novel scheme based on the measurement of Compton scatter photons. In our method, a slit x-ray beam along the superior-inferior direction is directed to the patient, (intersecting the lung region at a 2D plane) containing most of the tumor motion trajectory. X-ray photons are scattered off this plane primarily due to the Compton interaction. An imager with a pinhole or a slat collimator is placed at one side of the plane to capture the scattered photons. The resulting image, after correcting for incoming fluence inhomogeneity, x-ray attenuation, scatter angle variation, and outgoing beam geometry, represents the linear attenuation coefficient of Compton scattering. This allows the visualization of the anatomy on this plane. We performed Monte Carlo simulation studies both on a phantom and a patient for proof-of-principle purposes. In the phantom case, a small tumor-like structure could be clearly visualized. The contrast-resolution calculated using tumor/lung as foreground/background for kV fluoroscopy, cone beam computed tomography (CBCT), and scattering image were 0.037, 0.70, and 0.54, respectively. In the patient case, tumor motion could be clearly observed in the scatter images. Imaging dose to the voxels directly exposed by the slit beam was ~0.4 times of that under a single CBCT projection. These studies demonstrated the potential feasibility of the proposed imaging scheme to capture the instantaneous anatomy of a patient on a 2D plane with a high image contrast. Clear visualization of the tumor motion may facilitate marker-less tumor tracking.
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Yorke E, Xiong Y, Han Q, Zhang P, Mageras G, Lovelock M, Pham H, Xiong JP, Goodman KA. Kilovoltage Imaging of Implanted Fiducials to Monitor Intrafraction Motion With Abdominal Compression During Stereotactic Body Radiation Therapy for Gastrointestinal Tumors. Int J Radiat Oncol Biol Phys 2015; 95:1042-1049. [PMID: 26797539 DOI: 10.1016/j.ijrobp.2015.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/15/2015] [Accepted: 11/11/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE To assess intrafraction respiratory motion using a commercial kilovoltage imaging system for abdominal tumor patients with implanted fiducials and breathing constrained by pneumatic compression during stereotactic body radiation therapy (SBRT). METHODS AND MATERIALS A pneumatic compression belt limited respiratory motion in 19 patients with radiopaque fiducials in or near their tumor during SBRT for abdominal tumors. Kilovoltage images were acquired at 5- to 6-second intervals during treatment using a commercial system. Intrafractional fiducial displacements were measured using in-house software. The dosimetric effect of the observed displacements was calculated for 3 sessions for each patient. RESULTS Intrafraction displacement patterns varied between patients and between individual treatment sessions. Averaged over 19 patients, 73 sessions, 7.6% of craniocaudal displacements exceeded 0.5 cm, and 1.2% exceeded 0.75 cm. The calculated single-session dose to 95% of gross tumor volume differed from planned by an average of -1.2% (range, -11.1% to 4.8%) but only for 4 patients was the total 3-session calculated dose to 95% of gross tumor volume more than 3% different from planned. CONCLUSIONS Our pneumatic compression limited intrafractional abdominal target motion, maintained target position established at setup, and was moderately effective in preserving coverage. Commercially available intrafractional imaging is useful for surveillance but can be made more effective and reliable.
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Affiliation(s)
- Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Ying Xiong
- Department of Radiation Oncology, China-Japan Friendship Hospital, Beijing, China
| | - Qian Han
- Department of Radiotherapy, Henan Provincial People's Hospital, Zhengzhou, China
| | - Pengpeng Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gikas Mageras
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Lovelock
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hai Pham
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jian-Ping Xiong
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karyn A Goodman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Shrestha UM, Seo Y, Botvinick EH, Gullberg GT. Image reconstruction in higher dimensions: myocardial perfusion imaging of tracer dynamics with cardiac motion due to deformation and respiration. Phys Med Biol 2015; 60:8275-301. [PMID: 26450115 DOI: 10.1088/0031-9155/60/21/8275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Myocardial perfusion imaging (MPI) using slow rotating large field of view cameras requires spatiotemporal reconstruction of dynamically acquired data to capture the time variation of the radiotracer concentration. In vivo, MPI contains additional degrees of freedom involving unavoidable motion of the heart due to quasiperiodic beating and the effects of respiration, which can severely degrade the quality of the images. This work develops a technique for a single photon emission computed tomography (SPECT) that reconstructs the distribution of the radiotracer concentration in the myocardium using a tensor product of different sets of basis functions that approximately describe the spatiotemporal variation of the radiotracer concentration and the motion of the heart. In this study the temporal B-spline basis functions are chosen to reflect the dynamics of the radiotracer, while the intrinsic deformation and the extrinsic motion of the heart are described by a product of a discrete set of Gaussian basis functions. Reconstruction results are presented showing the dynamics of the tracer in the myocardium as it deforms due to cardiac beating, and is displaced due to respiratory motion. These results are compared with the conventional 4D-spatiotemporal reconstruction method that models only the temporal changes of the tracer activity. The higher dimensional reconstruction method proposed here improves bias, yet the signal-to-noise ratio (SNR) decreases slightly due to redistribution of the counts over the cardiac-respiratory gates. Additionally, there is a trade-off between the number of gates and the number of projections per gate to achieve high contrast images.
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Affiliation(s)
- Uttam M Shrestha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA. Structural Biology and Imaging Department, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
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The feasibility assessment of radiation dose of movement 3D NIPAM gel by magnetic resonance imaging. Radiat Phys Chem Oxf Engl 1993 2015. [DOI: 10.1016/j.radphyschem.2015.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Yu J, Choi JH, Ma SY, Jeung TS, Lim S. Comparison between audio-only and audiovisual biofeedback for regulating patients' respiration during four-dimensional radiotherapy. Radiat Oncol J 2015; 33:250-5. [PMID: 26484309 PMCID: PMC4607579 DOI: 10.3857/roj.2015.33.3.250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/07/2015] [Accepted: 09/11/2015] [Indexed: 12/25/2022] Open
Abstract
Purpose To compare audio-only biofeedback to conventional audiovisual biofeedback for regulating patients' respiration during four-dimensional radiotherapy, limiting damage to healthy surrounding tissues caused by organ movement. Materials and Methods Six healthy volunteers were assisted by audiovisual or audio-only biofeedback systems to regulate their respirations. Volunteers breathed through a mask developed for this study by following computer-generated guiding curves displayed on a screen, combined with instructional sounds. They then performed breathing following instructional sounds only. The guiding signals and the volunteers' respiratory signals were logged at 20 samples per second. Results The standard deviations between the guiding and respiratory curves for the audiovisual and audio-only biofeedback systems were 21.55% and 23.19%, respectively; the average correlation coefficients were 0.9778 and 0.9756, respectively. The regularities between audiovisual and audio-only biofeedback for six volunteers' respirations were same statistically from the paired t-test. Conclusion The difference between the audiovisual and audio-only biofeedback methods was not significant. Audio-only biofeedback has many advantages, as patients do not require a mask and can quickly adapt to this method in the clinic.
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Affiliation(s)
- Jesang Yu
- Department of Radiation Oncology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Ji Hoon Choi
- Department of Radiation Oncology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Sun Young Ma
- Department of Radiation Oncology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Tae Sig Jeung
- Department of Radiation Oncology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Sangwook Lim
- Department of Radiation Oncology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
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Patel R, Panfil J, Campana M, Block AM, Harkenrider MM, Surucu M, Roeske JC. Markerless motion tracking of lung tumors using dual-energy fluoroscopy. Med Phys 2015; 42:254-62. [PMID: 25563265 DOI: 10.1118/1.4903892] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the efficacy of dual-energy (DE) vs single-energy (SE) fluoroscopic imaging of lung tumors using a markerless template-based tracking algorithm. METHODS Ten representative patient breathing patterns were programmed into a Quasar™ motion phantom. The phantom was modified by affixing pork ribs to the surface, and a cedar insert with a small spherical volume was used to simulate lung and tumor, respectively. Sequential 60 kVp (6 mA) and 120 kVp (1.5 mA) fluoroscopic sequences were acquired. Frame-by-frame weighted logarithmic subtraction was performed resulting in a DE fluoroscopic sequence. A template-based algorithm was then used to track tumor motion throughout the DE and SE fluoroscopy sequences. Tracking coordinates were evaluated against ground-truth tumor locations. Fluoroscopic images were also acquired for two lung cancer patients, neither of which had implanted fiducials. RESULTS For phantom imaging, a total of 1925 frames were analyzed. The algorithm successfully tracked the target on 99.9% (1923/1925) of DE frames vs 90.7% (1745/1925) SE images (p < 0.01). The displacement between tracking coordinates and ground truth for the phantom was 1.4 mm ± 1.1 mm for DE vs 2.0 mm ± 1.3 mm for SE (p < 0.01). Images from two patients, one with a larger tumor and one with a smaller tumor, were also analyzed. For the patient with the larger tumor, the average displacement from physician defined ground truth was 1.2 mm ± 0.6 mm for DE vs 1.4 mm ± 0.7 mm for SE (p = 0.016). For the patient that presented with a smaller tumor, the average displacement from physician defined ground truth was 2.2 mm ± 1.0 mm for DE vs 3.2 mm ± 1.4 mm for SE (p < 0.01). Importantly, for this single patient with the smaller tumor, 15.6% of the SE frames had >5 mm displacements from the ground truth vs 0% for DE fluoroscopy. CONCLUSIONS This work indicates the potential for markerless tumor tracking utilizing DE fluoroscopy. With DE imaging, the algorithm showed improved detectability vs SE fluoroscopy and was able to accurately track the tumor in nearly all cases.
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Affiliation(s)
- Rakesh Patel
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois 60153
| | - Joshua Panfil
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois 60153
| | - Maria Campana
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois 60153
| | - Alec M Block
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois 60153
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois 60153
| | - Murat Surucu
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois 60153
| | - John C Roeske
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois 60153
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Rong Y, Bazan JG, Sekhon A, Haglund K, Xu-Welliver M, Williams T. Minimal Inter-Fractional Fiducial Migration during Image-Guided Lung Stereotactic Body Radiotherapy Using SuperLock Nitinol Coil Fiducial Markers. PLoS One 2015; 10:e0131945. [PMID: 26158847 PMCID: PMC4497733 DOI: 10.1371/journal.pone.0131945] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/08/2015] [Indexed: 12/26/2022] Open
Abstract
Objectives Stereotactic body radiotherapy (SBRT) is being increasingly used for the treatment of patients with lung cancer or lung metastasis who are medically unfit to undergo resection. In order to improve accuracy and confidence in targeting tumors, many centers rely on fiducial implantation. We evaluated the migration of a novel fiducial marker specifically designed for lung tissue implanted via electromagnetic navigation bronchoscopy (ENB). Methods We retrospectively quantified the individual and group migrations of SuperLock nitinol coil fiducials for 15 patients receiving lung stereotactic body radiotherapy (SBRT), in order to evaluate the reliability of using these fiducials as a target surrogate for cases where tumors cannot be clearly delineated on cone beam CTs (CBCTs). For each fraction, we compared the individual and group migrations of the fiducials between the planning CT and the acquired CBCT. The group migration was defined as the distance between the centroids of the fiducial group and GTV. Results A total of 16 lung targets were included in our study for these 15 patients (one patient with two targets). Of 55 fiducials placed, we observed a 100% retention rate. The mean individual migration was 1.87 mm (range, 0.63–5.25 mm) with a standard deviation of 1.26 mm. The mean group migration was 1.94 mm (range, 0.03–6.19 mm) with a standard deviation of 1.45 mm. Overall, there was minimal change in the relative locations of the markers with respect to each other, as well as to the target. Conclusions We found that the SuperLock nitinol coil fiducial marker positions are stable throughout the radiation treatment, and can be used as a reliable surrogate to target, and to avoid geometric misses during gated treatments.
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Affiliation(s)
- Yi Rong
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, 95817, United States of America
- * E-mail: (YR); (TW)
| | - Jose G. Bazan
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States of America
| | - Ashley Sekhon
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States of America
| | - Karl Haglund
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States of America
| | - Meng Xu-Welliver
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States of America
| | - Terence Williams
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States of America
- * E-mail: (YR); (TW)
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Franks K, Jain P, Snee M. Stereotactic Ablative Body Radiotherapy for Lung Cancer. Clin Oncol (R Coll Radiol) 2015; 27:280-9. [DOI: 10.1016/j.clon.2015.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/20/2015] [Indexed: 02/08/2023]
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Castillo SJ, Castillo R, Castillo E, Pan T, Ibbott G, Balter P, Hobbs B, Guerrero T. Evaluation of 4D CT acquisition methods designed to reduce artifacts. J Appl Clin Med Phys 2015; 16:4949. [PMID: 26103169 PMCID: PMC4504190 DOI: 10.1120/jacmp.v16i2.4949] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 11/21/2014] [Accepted: 11/09/2014] [Indexed: 12/25/2022] Open
Abstract
Four-dimensional computed tomography (4D CT) is used to account for respiratory motion in radiation treatment planning, but artifacts resulting from the acquisition and postprocessing limit its accuracy. We investigated the efficacy of three experimental 4D CT acquisition methods to reduce artifacts in a prospective institutional review board approved study. Eighteen thoracic patients scheduled to undergo radiation therapy received standard clinical 4D CT scans followed by each of the alternative 4D CT acquisitions: 1) data oversampling, 2) beam gating with breathing irregularities, and 3) rescanning the clinical acquisition acquired during irregular breathing. Relative values of a validated correlation-based artifact metric (CM) determined the best acquisition method per patient. Each 4D CT was processed by an extended phase sorting approach that optimizes the quantitative artifact metric (CM sorting). The clinical acquisitions were also postprocessed by phase sorting for artifact comparison of our current clinical implementation with the experimental methods. The oversampling acquisition achieved the lowest artifact presence among all acquisitions, achieving a 27% reduction from the current clinical 4D CT implementation (95% confidence interval = 34-20). The rescan method presented a significantly higher artifact presence from the clinical acquisition (37%; p < 0.002), the gating acquisition (26%; p < 0.005), and the oversampling acquisition (31%; p < 0.001), while the data lacked evidence of a significant difference between the clinical, gating, and oversampling methods. The oversampling acquisition reduced artifact presence from the current clinical 4D CT implementation to the largest degree and provided the simplest and most reproducible implementation. The rescan acquisition increased artifact presence significantly, compared to all acquisitions, and suffered from combination of data from independent scans over which large internal anatomic shifts occurred.
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