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Ultrasonography and transillumination for uveal melanoma localisation in proton beam treatment planning. Eye (Lond) 2019; 33:1904-1910. [PMID: 31278380 DOI: 10.1038/s41433-019-0512-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 05/07/2019] [Accepted: 05/31/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVE The success of proton beam treatment (PBT) in uveal melanoma depends in part on the accuracy of tumour localisation. This study determined if using ultrasonography (US) to measure the distance between tumour margin and tantalum ring (DTR) in PBT planning improves local treatment success when compared with using intraoperative transillumination (TI) alone. METHODS Retrospective analysis of patients with uveal melanoma treated at one centre between January 2006 and June 2017 with ≥12-month follow-up (or until treatment failure). Local tumour control was compared among study groups based on methods for measuring DTR: Group 1 (TI alone), Group 2A (postoperative US alone) and Group 2B (combination). RESULTS Fifty-four eyes (54 patients) with uveal melanomas were included: Group 1 (22 eyes, 41%), Group 2A (11 eyes, 20%) and Group 2B (21 eyes, 39%). Mean age at diagnosis was 64 years [median 66 years, range 23-86 years]. Fifty tumours (93%) involved the choroid, while four involved the ciliary body (7%). In Group 2B, PBT treatment was based on the DTR obtained using US; DTR differed between TI and US by ≥1 mm for 25 rings in 16 eyes and ≥2 mm for 12 rings in 7 eyes. Five-year Kaplan-Meier estimate revealed a difference in local treatment success between Groups 1 and 2, (0.82 vs. 1.0, p = 0.02) with no difference in overall survival estimate, (0.85 vs. 0.83, p = 0.8). CONCLUSIONS US can be used to measure DTR in PBT planning for uveal melanoma. This may improve accuracy of tumour localisation and improve local treatment success.
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Roberts PR, Jani AB, Packianathan S, Albert A, Bhandari R, Vijayakumar S. Upcoming imaging concepts and their impact on treatment planning and treatment response in radiation oncology. Radiat Oncol 2018; 13:146. [PMID: 30103786 PMCID: PMC6088418 DOI: 10.1186/s13014-018-1091-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/31/2018] [Indexed: 12/14/2022] Open
Abstract
For 2018, the American Cancer Society estimated that there would be approximately 1.7 million new diagnoses of cancer and about 609,640 cancer-related deaths in the United States. By 2030 these numbers are anticipated to exceed a staggering 21 million annual diagnoses and 13 million cancer-related deaths. The three primary therapeutic modalities for cancer treatments are surgery, chemotherapy, and radiation therapy. Individually or in combination, these treatment modalities have provided and continue to provide curative and palliative care to the myriad victims of cancer. Today, CT-based treatment planning is the primary means through which conventional photon radiation therapy is planned. Although CT remains the primary treatment planning modality, the field of radiation oncology is moving beyond the sole use of CT scans to define treatment targets and organs at risk. Complementary tissue scans, such as magnetic resonance imaging (MRI) and positron electron emission (PET) scans, have all improved a physician’s ability to more specifically identify target tissues, and in some cases, international guidelines have even been issued. Moreover, efforts to combine PET and MR to define solid tumors for radiotherapy planning and treatment evaluation are also gaining traction. Keeping these advances in mind, we present brief overviews of other up-and-coming key imaging concepts that appear promising for initial treatment target definition or treatment response from radiation therapy.
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Affiliation(s)
- Paul Russell Roberts
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 Woodrow Wilson Drive Suite 1600, Jackson, MS, 39213, USA
| | - Ashesh B Jani
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, 30322, USA
| | - Satyaseelan Packianathan
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 Woodrow Wilson Drive Suite 1600, Jackson, MS, 39213, USA
| | - Ashley Albert
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 Woodrow Wilson Drive Suite 1600, Jackson, MS, 39213, USA
| | - Rahul Bhandari
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 Woodrow Wilson Drive Suite 1600, Jackson, MS, 39213, USA
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 Woodrow Wilson Drive Suite 1600, Jackson, MS, 39213, USA.
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Clinical Outcomes of Proton Radiotherapy for Uveal Melanoma. Clin Oncol (R Coll Radiol) 2016; 28:e17-27. [PMID: 26915706 DOI: 10.1016/j.clon.2016.01.034] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/20/2015] [Accepted: 01/05/2016] [Indexed: 02/03/2023]
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Coleman DJ, Silverman RH, Rondeau MJ, Lloyd HO, Daly S. Explaining The Current Role Of High Frequency Ultrasound In Ophthalmic Diagnosis (Ophthalmic Ultrasound). EXPERT REVIEW OF OPHTHALMOLOGY 2014; 1:63-76. [PMID: 20037660 DOI: 10.1586/17469899.1.1.63] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ultrasound has become as indispensable as indirect ophthalmoscopy or slit lamp in evaluation of the eye. It is an important adjuvant for the clinical assessment of a variety of ocular and orbital diseases. Advances in instrumentation, higher frequencies and more sensitivity and resolution have resulted in continuous improvement in image quality.Very high frequency ultrasound uses frequencies in the range of 35 to 100 MHz to show greater detail of the anterior segment. Penetration is limited for these higher frequencies to only a few millimeters and thus only the anterior vitreous behind the ciliary body and lens can be imaged. High frequency ultrasound in the range of 20 to 30 MHz has a penetration of about 10 mm and can be used for posterior pole evaluation of the retina and choroid.
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Affiliation(s)
- D Jackson Coleman
- Margaret M. Dyson Vision Research Institute, Department of Ophthalmology, Weill Medical College of Cornell University, New York, NY
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Brinton MR, Stewart RJ, Cheung AK, Christensen DA, Shiu YTE. Modelling ultrasound-induced mild hyperthermia of hyperplasia in vascular grafts. Theor Biol Med Model 2011; 8:42. [PMID: 22054016 PMCID: PMC3217891 DOI: 10.1186/1742-4682-8-42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 11/03/2011] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Expanded polytetrafluoroethylene (ePTFE) vascular grafts frequently develop occlusive neointimal hyperplasia as a result of myofibroblast over-growth, leading to graft failure. ePTFE exhibits higher ultrasound attenuation than native soft tissues. We modelled the selective absorption of ultrasound by ePTFE, and explored the feasibility of preventing hyperplasia in ePTFE grafts by ultrasound heating. Specifically, we simulated the temperature profiles of implanted grafts and nearby soft tissues and blood under ultrasound exposure. The goal was to determine whether ultrasound exposure of an ePTFE graft can generate temperatures sufficient to prevent cell growth on the graft without damaging nearby soft tissues and blood. METHODS Ultrasound beams from two transducers (1.5 and 3.2 MHz) were simulated in two graft/tissue models, with and without an intra-graft cellular layer mimicking hyperplasia, using the finite-difference time-domain (FDTD) method. The resulting power deposition patterns were used as a heat source for the Pennes bioheat equation in a COMSOL(®) Multiphysics heat transfer model. 50°C is known to cause cell death and therefore the transducer powers were adjusted to produce a 13°C temperature rise from 37°C in the ePTFE. RESULTS Simulations showed that both the frequency of the transducers and the presence of hyperplasia significantly affect the power deposition patterns and subsequent temperature profiles on the grafts and nearby tissues. While neither transducer significantly raised the temperature of the blood, the 1.5-MHz transducer was less focused and heated larger volumes of the graft and nearby soft tissues than the 3.2-MHz transducer. The presence of hyperplasia had little effect on the blood's temperature, but further increased the temperature of the graft and nearby soft tissues in response to either transducer. Skin cooling and blood flow play a significant role in preventing overheating of the native tissues. CONCLUSIONS Modelling shows that ultrasound can selectively heat ePTFE grafts and produce temperatures that cause cell death on the graft. The temperature increase in blood is negligible and that in the adjacent soft tissues may be minimized by skin cooling and using appropriate transducers. Therefore, ultrasound heating may have the potential to reduce neointimal hyperplasia and failure of ePTFE vascular grafts.
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Affiliation(s)
- Mark R Brinton
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, UT, USA
- Department of Electrical Engineering, Stanford University, 350 Serra Mall (Mail Code: 9505), Stanford, CA 94305-9505, USA
| | - Russell J Stewart
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Alfred K Cheung
- Department of Medicine, Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA
- Medical Service, Veterans Affairs Salt Lake City Healthcare System, UT, USA
| | - Douglas A Christensen
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, UT, USA
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Yan-Ting E Shiu
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
- Department of Medicine, Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA
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Liao AH, Chen LY, Cheng WF, Li PC. A three-dimensional registration method for microUS/ microPET multimodality small-animal imaging. ULTRASONIC IMAGING 2007; 29:155-166. [PMID: 18092672 DOI: 10.1177/016173460702900302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Small-animal models are used extensively in disease research, genomics research, drug development and developmental biology. The development of noninvasive small-animal imaging techniques with adequate spatial resolution and sensitivity is therefore of prime importance. In particular, multimodality small-animal imaging can provide complementary information. This paper presents a method for registering high-frequency ultrasonic (microUS) images with small-animal positron-emission tomography (microPET) images. Registration is performed using six external multimodality markers, each being a glass bead with a diameter of 0.43-0.60 mm, with 0.1 microl of [18F]FDG placed in each marker holder. A small-animal holder is used to transfer mice between the microPET and microUS systems. Multimodality imaging was performed on C57BL/6J black mice bearing WF-3 ovary cancer cells in the second week after tumor implantation and rigid-body image registration of the six markers was also performed. The average registration error was 0.31 mm when all six markers were used and increased as the number of markers decreased. After image registration, image segmentation and fusion are performed on the tumor. Our multimodality small-animal imaging method allows structural information from microUS to be combined with functional information from microPET, with the preliminary results showing it to be an effective tool for cancer research.
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Affiliation(s)
- Ai-Ho Liao
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
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Daftari IK, Aghaian E, O'Brien JM, Dillon W, Phillips TL. 3D MRI-based tumor delineation of ocular melanoma and its comparison with conventional techniques. Med Phys 2005; 32:3355-62. [PMID: 16372413 DOI: 10.1118/1.2068927] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aim of this study is to (1) compare the delineation of the tumor volume for ocular melanoma on high-resolution three-dimensional (3D) T2-weighted fast spin echo magnetic resonance imaging (MRI) images with conventional techniques of A- and B-scan ultrasound, transcleral illumination, and placement of tantalum markers around tumor base and (2) to evaluate whether the surgically placed marker ring tumor delineation can be replaced by 3D MRI based tumor delineation. High-resolution 3D T2-weighted fast spin echo (3D FSE) MRI scans were obtained for 60 consecutive ocular melanoma patients using a 1.5 T MRI (GE Medical Systems, Milwaukee, WI), in a standard head coil. These patients were subsequently treated with proton beam therapy at the UC Davis Cyclotron, Davis, CA. The tumor was delineated by placement of tantalum rings (radio-opaque markers) around the tumor periphery as defined by pupillary transillumination during surgery. A point light source, placed against the sclera, was also used to confirm ring agreement with indirect ophthalmoscopy. When necessary, intraoperative ultrasound was also performed. The patients were planned using EYEPLAN software and the tumor volumes were obtained. For analysis, the tumors were divided into four categories based on tumor height and basal diameter. In order to assess the impact of high-resolution 3D T2 FSE MRI, the tumor volumes were outlined on the MRI scans by two independent observers and the tumor volumes calculated for each patient. Six (10%) of 60 patients had tumors, which were not visible on 3D MRI images. These six patients had tumors with tumor heights < or = 3 mm. A small intraobserver variation with a mean of (-0.22 +/- 4)% was seen in tumor volumes delineated by 3D T2 FSE MR images. The ratio of tumor volumes measured on MRI to EYEPLAN for the largest to the smallest tumor volumes varied between 0.993 and 1.02 for 54 patients. The tumor volumes measured directly on 3D T2 FSE MRI ranged from 4.03 to 0.075 cm3. with a mean of 0.87 +/- 0.84 cm3. The tumor shapes obtained from 3D T2 FSE MR images were comparable to the tumor shapes obtained using EYEPLAN software. The demonstration of intraocular tumor volumes with the high-resolution 3D fast spin echo T2 weighted MRI is excellent and provides additional information on tumor shape. We found a high degree of accuracy for tumor volumes with direct MRI volumetric measurements in uveal melanoma patients. In some patients with extra large tumors, the tumor base and shape was modified, because of the additional information obtained from 3D T2 FSE MR images.
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Affiliation(s)
- Inder k Daftari
- Department of Radiation Oncology, University of California, San Francisco, California 94143, USA.
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Bondiau PY, Malandain G, Chauvel P, Peyrade F, Courdi A, Iborra N, Caujolle JP, Gastaud P. Automatic three-dimensional model for protontherapy of the eye: preliminary results. Med Phys 2003; 30:1013-20. [PMID: 12852523 DOI: 10.1118/1.1564092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Recently, radiotherapy possibilities have been dramatically increased by software and hardware developments. Improvements in medical imaging devices have increased the importance of three-dimensional (3D) images as the complete examination of these data by a physician is not possible. Computer techniques are needed to present only the pertinent information for clinical applications. We describe a technique for an automatic 3D reconstruction of the eye and CT scan merging with fundus photographs (retinography). The final result is a "virtual eye" to guide ocular tumor protontherapy. First, we make specific software to automatically detect the position of the eyeball, the optical nerve, and the lens in the CT scan. We obtain a 3D eye reconstruction using this automatic method. Second, we describe the retinography and demonstrate the projection of this modality. Then we combine retinography with a reconstructed eye, using a CT scan to get a virtual eye. The result is a computer 3D scene rendering a virtual eye into a skull reconstruction. The virtual eye can be useful for the simulation, the planning, and the control of ocular tumor protontherapy. It can be adapted to treatment planning to automatically detect eye and organs at risk position. It should be highlighted that all the image processing is fully automatic to allow the reproduction of results, this is a useful property to conduct a consistent clinical validation. The automatic localization of the organ at risk in a CT scan or an MRI by automatic software could be of great interest for radiotherapy in the future for comparison of one patient at different times, the comparison of different treatments centers, the possibility of pooling results of different treatments centers, the automatic generation of doses-volumes histograms, the comparison between different treatment planning for the same patient and the comparison between different patients at the same time. It will also be less time consuming.
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