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de Mol van Otterloo S, Westerhoff J, Leer T, Rutgers R, Meijers L, Daamen L, Intven M, Verkooijen H. Patient expectation and experience of MR-guided radiotherapy using a 1.5T MR-Linac. Tech Innov Patient Support Radiat Oncol 2024; 29:100224. [PMID: 38162695 PMCID: PMC10755768 DOI: 10.1016/j.tipsro.2023.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/19/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024] Open
Abstract
Background and Purpose Online adaptive MR-guided radiotherapy (MRgRT) is a relatively new form of radiotherapy treatment, delivered using a MR-Linac. It is unknown what patients expect from this treatment and whether these expectations are met. This study evaluates whether patients' pre-treatment expectations of MRgRT are met and reports patients' on-table experience on a 1.5 T MR-Linac. Materials and methods All patients treated on the MR-Linac from November 2020 until April 2021, were eligible for inclusion. Patient expectation and experience were captured through questionnaires before, during, and three months after treatment. The on-table experience questionnaire included patient' physical and psychological coping. Patient-expected side effects, participation in daily and social activity, disease outcome and, disease related symptoms were compared to post-treatment experience. Results We included 113 patients who were primarily male (n = 100, 89 %), with a median age of 69 years (range 52-90). For on-table experience, ninety percent of patients (strongly) agreed to feeling calm during their treatment. Six and eight percent of patients found the treatment position or bed uncomfortable respectively. Twenty-eight percent of patients felt tingling sensations during treatment. After treatment, 79 % of patients' expectations were met. Most patients experienced an (better than) expected level of side effects (75 %), participation in daily- (83 %) and social activity (86 %) and symptoms (78 %). However, 33 % expected more treatment efficacy than experienced. Conclusion Treatment on the 1.5 T MR-Linac is well tolerated and meets patient expectations. Despite the fact that some patients expected greater treatment efficacy and the frequent occurrence of tingling sensations during treatment, most patient experiences were comparable or better than previously expected.
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Affiliation(s)
- S.R. de Mol van Otterloo
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands
| | - J.M. Westerhoff
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands
| | - T. Leer
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands
| | - R.H.A. Rutgers
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands
| | - L.T.C. Meijers
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands
| | - L.A. Daamen
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands
| | - M.P.W. Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands
| | - H.M. Verkooijen
- Division of Imaging, University Medical Center Utrecht, Utrecht, the Netherlands
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Willigenburg T, Zachiu C, Bol GH, de Groot-van Beugel EN, Lagendijk JJW, van der Voort van Zyp JRN, Raaymakers BW, de Boer JCJ. Clinical application of a sub-fractionation workflow for intrafraction re-planning during prostate radiotherapy treatment on a 1.5 Tesla MR-Linac: A practical method to mitigate intrafraction motion. Radiother Oncol 2022; 176:25-30. [PMID: 36113777 DOI: 10.1016/j.radonc.2022.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intrafraction motion during radiotherapy limits margin reduction and dose escalation. Magnetic resonance (MR)-guided linear accelerators (MR-Linac) have emphasised this issue by enabling intrafraction imaging. We present and clinically apply a new workflow to counteract systematic intrafraction motion during MR-guided stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS With the sub-fractionation workflow, the daily dose is delivered in multiple sequential parts (sub-fractions), each adapted to the latest anatomy. As each sub-fractionation treatment plan complies with the dose constraints, no online dose accumulation is required. Imaging and treatment planning are executed in parallel with dose delivery to minimise dead time, enabling an efficient workflow. The workflow was implemented on a 1.5 T MR-Linac and applied in 15 prostate cancer (PCa) patients treated with 5 × 7.25 Gy in two sub-fractions of 3.625 Gy (10 × 3.625 Gy in total). Intrafraction clinical target volume (CTV) motion was determined and compared to a workflow with single-plan delivery. Furthermore, required planning target volume (PTV) margins were determined. RESULTS Average on-table time was 42.7 min. Except for two fractions, all fractions were delivered within 60 min. Average intrafraction 3D CTV displacement (±standard deviation) was 1.1 mm (± 0.7) with the sub-fractionation workflow, whereas this was up to 3.5 mm (± 2.4) without sub-fractionation. Calculated PTV margins required with sub-fractionation were 1.0 mm (left-right), 2.4 mm (cranial-caudal), and 2.6 mm (anterior-posterior). CONCLUSION Feasibility of the sub-fractionation workflow was demonstrated in 15 PCa patients treated with two sub-fractions on a 1.5 T MR-Linac. The workflow allows for significant PTV margin reduction in these patients by reducing systematic intrafraction motion during SBRT.
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Affiliation(s)
- Thomas Willigenburg
- University Medical Center Utrecht, Department of Radiation Oncology, 3508 GA Utrecht, The Netherlands.
| | - Cornel Zachiu
- University Medical Center Utrecht, Department of Radiation Oncology, 3508 GA Utrecht, The Netherlands
| | - Gijsbert H Bol
- University Medical Center Utrecht, Department of Radiation Oncology, 3508 GA Utrecht, The Netherlands
| | | | - Jan J W Lagendijk
- University Medical Center Utrecht, Department of Radiation Oncology, 3508 GA Utrecht, The Netherlands
| | | | - Bas W Raaymakers
- University Medical Center Utrecht, Department of Radiation Oncology, 3508 GA Utrecht, The Netherlands
| | - Johannes C J de Boer
- University Medical Center Utrecht, Department of Radiation Oncology, 3508 GA Utrecht, The Netherlands
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Brink A, Stewart K, Hargrave C. Evaluation of dose accumulation methods and workflows utilising cone beam computed tomography images. J Med Radiat Sci 2022; 70 Suppl 2:26-36. [PMID: 36168134 PMCID: PMC10122928 DOI: 10.1002/jmrs.622] [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: 02/09/2022] [Accepted: 09/13/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Various adaptive radiation therapy (ART) methods have emerged, with little consensus amongst the literature as to which is most appropriate. This study aimed to compare dose mapping (DM) versus Monte Carlo recalculation (MCR), using cone beam computed tomography (CBCT) images when utilised in automated ART dose accumulation workflows in the MIM Maestro software package. METHODS The treatment plans for 38 cancer patients (19 prostate and 19 head and neck cases) were used to perform DM or MCR retrospectively upon CBCTs acquired during treatment, which were then deformably registered to the planning CT (DR-pCT) to facilitate dose accumulation. Dose-volume and region-of-interest data were extracted for the planning target volumes and organs at risk. Intraclass correlation (ICC) values and Bland-Altman plots were utilised to compare DM versus MCR doses on the CBCT images as well as CBCT versus DR-pCT doses. RESULTS When comparing DM and MCR on CBCTs, the differences across dose level mean dose differences were mostly within a ±5% level of agreement based on the Bland-Altman plots, with over 67% of ICC values over 0.9 and indicative of good correlation. When these distributions were deformed back to the planning CT, the agreement was reduced considerably, with larger differences (exceeding ±5%) resulting from workflow-related issues. CONCLUSION The results emphasise the need to consider and make adaptations to minimise the effect of workflows on algorithm performance. Manual user intervention, refined departmental protocols and further developments to the MIM Maestro software will enhance the use of this tool.
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Affiliation(s)
- Amelia Brink
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Radiation Oncology, Royal Brisbane and Women's Hospital (RBWH), Metro North Health Service District, Herston, Queensland, Australia
| | - Kate Stewart
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Radiation Oncology, Royal Brisbane and Women's Hospital (RBWH), Metro North Health Service District, Herston, Queensland, Australia
| | - Catriona Hargrave
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Radiation Oncology PAH - Raymond Terrace Campus, Division of Cancer Services, Metro South Health Service District, South Brisbane, Queensland, Australia
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Willigenburg T, Zachiu C, Lagendijk JJ, van der Voort van Zyp JR, de Boer HC, Raaymakers BW. Fast and accurate deformable contour propagation for intra-fraction adaptive magnetic resonance-guided prostate radiotherapy. Phys Imaging Radiat Oncol 2022; 21:62-65. [PMID: 35243033 PMCID: PMC8861825 DOI: 10.1016/j.phro.2022.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 12/02/2022] Open
Abstract
Accurate contours are needed for intra-fraction adaption using contour propagation. A deformable image registration algorithm (EVolution) was tested for this purpose. Clinical quality of intra-fraction propagated contours was assessed by 2 physicians. EVolution provided good results in 10 prostate cancer cases. This paves the way for adaptive workflows using deformable contour propagation.
To facilitate full intra-fraction adaptive MR-guided radiotherapy, accurate contour propagation is needed. We aimed to assess the clinical usability of intra-fraction propagated contours by a deformable image registration algorithm in ten prostate cancer patients. Two observers judged the contours on need for manual adaptation and feasibility of adapting contours within 3 min. CTV and bladder contours needed none or only minor editing in most cases (≥ 97%), whereas rectum contours needed more extensive editing in 12–23%. Nevertheless, adaptation times were < 3 min for ≥ 93% of the cases. This paves the way for exploring adaptive workflows using intra-fraction deformable contour propagation.
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Affiliation(s)
- Thomas Willigenburg
- Corresponding author at: University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Levegrün S, Pöttgen C, Xydis K, Guberina M, Abu Jawad J, Stuschke M. Spatial and dosimetric evaluation of residual distortions of prostate and seminal vesicle bed after image-guided definitive and postoperative radiotherapy of prostate cancer with endorectal balloon. J Appl Clin Med Phys 2020; 22:226-241. [PMID: 33377614 PMCID: PMC7856505 DOI: 10.1002/acm2.13138] [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: 06/25/2020] [Revised: 10/27/2020] [Accepted: 11/25/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To quantify daily residual deviations from the planned geometry after image‐guided prostate radiotherapy with endorectal balloon and to evaluate their effect on the delivered dose distribution. Methods Daily kV‐CBCT imaging was used for online setup‐correction in six degrees of freedom (6‐dof) for 24 patients receiving definitive (12 RTdef patients) or postoperative (12 RTpostop patients) radiotherapy with endorectal balloon (overall 739 CBCTs). Residual deviations were evaluated using several spatial and dosimetric variables, including: (a) posterior Hausdorff distance HDpost (=maximum distance between planned and daily CTV contour), (b) point Pworst with largest HDpost over all fractions, (c) equivalent uniform dose using a cell survival model (EUDSF) and the generalized EUD concept (gEUDa with parameter a = −7 and a = −20). EUD values were determined for planned (EUDSFplan), daily (EUDSFind), and delivered dose distributions (EUDSFaccum) for plans with 6 mm (=clinical plans) and 2 mm CTV‐to‐PTV margin. Time series analyses of interfractional spatial and dosimetric deviations were conducted. Results Large HDpost values ≥ 12.5 mm (≥15 mm) were observed in 20/739 (5/739) fractions distributed across 7 (3) patients. Points Pworst were predominantly located at the posterior CTV boundary in the seminal vesicle region (16/24 patients, 6/7 patients with HDpost ≥ 12.5 mm). Time series analyses revealed a stationary white noise characteristic of HDpost and relative dose at Pworst. The EUDSF difference between planned and accumulated dose distributions was < 5.4% for all 6‐mm plans. Evaluating 2‐mm plans, EUDSF deteriorated by < 10% (<5%) in 75% (58.5%) of the patients. EUDSFaccum was well described by the median value of the EUDSFind distribution. PTV margin calculation at Pworst yielded 8.8 mm. Conclusions Accumulated dose distributions in prostate radiotherapy with endorectal balloon are forgiving of considerable residual distortions after 6‐dof patient setup if they are observed in a minority of fractions and the median value of EUDSFind determined per fraction stays within 95% of prescribed dose. Common PTV margin calculations are overly conservative because after online correction of translational and rotational errors only residual deformations need to be included. These results provide guidelines regarding online navigation, margin optimization, and treatment adaptation strategies.
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Affiliation(s)
- Sabine Levegrün
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
| | | | - Maja Guberina
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
| | - Jehad Abu Jawad
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
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Giacometti V, Hounsell AR, McGarry CK. A review of dose calculation approaches with cone beam CT in photon and proton therapy. Phys Med 2020; 76:243-276. [DOI: 10.1016/j.ejmp.2020.06.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 01/12/2023] Open
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Cunningham JM, Barberi EA, Miller J, Kim JP, Glide-Hurst CK. Development and evaluation of a novel MR-compatible pelvic end-to-end phantom. J Appl Clin Med Phys 2018; 20:265-275. [PMID: 30411477 PMCID: PMC6333127 DOI: 10.1002/acm2.12455] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 05/22/2018] [Accepted: 08/22/2018] [Indexed: 12/25/2022] Open
Abstract
MR-only treatment planning and MR-IGRT leverage MRI's powerful soft tissue contrast for high-precision radiation therapy. However, anthropomorphic MR-compatible phantoms are currently limited. This work describes the development and evaluation of a custom-designed, modular, pelvic end-to-end (PETE) MR-compatible phantom to benchmark MR-only and MR-IGRT workflows. For construction considerations, subject data were assessed for phantom/skeletal geometry and internal organ kinematics to simulate average male pelvis anatomy. Various materials for the bone, bladder, and rectum were evaluated for utility within the phantom. Once constructed, PETE underwent CT-SIM, MR-Linac, and MR-SIM imaging to qualitatively assess organ visibility. Scans were acquired with various bladder and rectal volumes to assess component interactions, filling capabilities, and filling reproducibility via volume and centroid differences. PETE simulates average male pelvis anatomy and comprises an acrylic body oval (height/width = 23.0/38.1 cm) and a cast-mold urethane skeleton, with silicone balloons simulating bladder and rectum, a silicone sponge prostate, and hydrophilic poly(vinyl alcohol) foam to simulate fat/tissue separation between organs. Access ports enable retrofitting the phantom with other inserts including point/film-based dosimetry options. Acceptable contrast was achievable in CT-SIM and MR-Linac images. However, the bladder was challenging to distinguish from background in CT-SIM. The desired contrast for T1-weighted and T2-weighted MR-SIM (dark and bright bladders, respectively) was achieved. Rectum and bone exhibited no MR signal. Inputted volumes differed by <5 and <10 mL from delineated rectum (CT-SIM) and bladder (MR-SIM) volumes. Increasing bladder and rectal volumes induced organ displacements and shape variations. Reproduced volumes differed by <4.5 mL, with centroid displacements <1.4 mm. A point dose measurement with an MR-compatible ion chamber in an MR-Linac was within 1.5% of expected. A novel, modular phantom was developed with suitable materials and properties that accurately and reproducibly simulate status changes with multiple dosimetry options. Future work includes integrating more realistic organ models to further expand phantom options.
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Affiliation(s)
| | | | - John Miller
- Modus Medical Devices Inc., London, ON, Canada
| | - Joshua P Kim
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Carri K Glide-Hurst
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
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Glide-Hurst C, Nejad-Davarani S, Weiss S, Zheng W, Chetty IJ, Renisch S. Per-organ assessment of subject-induced susceptibility distortion for MR-only male pelvis treatment planning. Radiat Oncol 2018; 13:149. [PMID: 30111376 PMCID: PMC6094890 DOI: 10.1186/s13014-018-1090-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/27/2018] [Indexed: 11/22/2022] Open
Abstract
Background Patient-specific distortions, particularly near tissue/air interfaces, require assessment for magnetic resonance (MR) only radiation treatment planning (RTP). However, patients are dynamic due to changes in physiological status during imaging sessions. This work investigated changes in subject-induced susceptibility distortions to pelvic organs at different bladder states to support pelvis MR-only RTP. Methods Pelvises of 9 healthy male volunteers were imaged at 1.0 Tesla (T), 1.5 T, and 3.0 T. Subject-induced susceptibility distortion field maps were generated using a dual-echo gradient-recalled echo (GRE) sequence with B0 field maps obtained from the phase difference between the two echoes acquired at several bladder volume states (3–4/subject, 32 overall). T2 turbo spin echo images were also acquired at each bladder state for organ delineation. Magnet central frequency was tracked over time. Distortion map differences and boxplots were computed to characterize changes within the clinical target volume (CTV), bladder, seminal vesicles, and prostate volumes. Results The time between the initial and final B0 maps was 42.6 ± 13.9 (range: 13.2–62.1) minutes with minimal change in magnet central frequency (0.02 ± 0.05 mm (range: − 0.06 – 0.12 mm)). Subject-induced susceptibility distortion across all bladder states, field strengths, and subjects was relatively small (1.4–1.9% of all voxels in the prostate and seminal vesicles were distorted > 0.5 mm). In the bladder, no voxels exhibited distortions > 1 mm. An extreme case acquired at 3.0 T with a large volume of rectal air yielded 27.4–34.6% of voxels within the CTVs had susceptibility-induced distortions > 0.5 mm across all time points. Conclusions Our work suggests that subject-induced susceptibility distortions caused by bladder/rectal conditions are generally small and subject-dependent. Local changes may be non-negligible within the CTV, thus proper management of filling status is warranted. Future work evaluating the impact of multiple models to accommodate for extreme status changes may be advantageous.
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Affiliation(s)
- Carri Glide-Hurst
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI, 48202, USA.
| | - Siamak Nejad-Davarani
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI, 48202, USA
| | - Steffen Weiss
- Department of Digital Imaging, Philips Research Laboratories, 22335, Hamburg, Germany
| | - Weili Zheng
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI, 48202, USA
| | - Steffen Renisch
- Department of Digital Imaging, Philips Research Laboratories, 22335, Hamburg, Germany
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Hysing LB, Ekanger C, Zolnay Á, Helle SI, Rasi M, Heijmen BJ, Sikora M, Söhn M, Muren LP, Thörnqvist S. Statistical motion modelling for robust evaluation of clinically delivered accumulated dose distributions after curative radiotherapy of locally advanced prostate cancer. Radiother Oncol 2018; 128:327-335. [DOI: 10.1016/j.radonc.2018.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 05/16/2018] [Accepted: 06/04/2018] [Indexed: 12/25/2022]
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Fukumitsu N, Takahashi S, Okumura T, Ishida T, Murofushi KN, Ohnishi K, Aihara T, Ishikawa H, Tsuboi K, Sakurai H. Normal liver tissue change after proton beam therapy. Jpn J Radiol 2018; 36:559-565. [PMID: 29980916 DOI: 10.1007/s11604-018-0757-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/27/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Nobuyoshi Fukumitsu
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan.
| | - Shinsei Takahashi
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Toshiyuki Okumura
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Toshiki Ishida
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Keiko Nemoto Murofushi
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Kayoko Ohnishi
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Teruhito Aihara
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Hitoshi Ishikawa
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Koji Tsuboi
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Hideyuki Sakurai
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
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Hargrave C, Deegan T, Bednarz T, Poulsen M, Harden F, Mengersen K. An image‐guided radiotherapy decision support framework incorporating a Bayesian network and visualization tool. Med Phys 2018; 45:2884-2897. [DOI: 10.1002/mp.12979] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/01/2018] [Accepted: 04/14/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Catriona Hargrave
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- School of Clinical Sciences Faculty of Health Queensland University of Technology Brisbane 4000 Australia
| | - Timothy Deegan
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
| | - Tomasz Bednarz
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- Data 61 Commonwealth Scientific and Industrial Research Organisation Brisbane 4102 Australia
- Expanded Perception and Interaction Centre University of New South Wales Paddington 2021 Australia
| | - Michael Poulsen
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
- Faculty of Medicine University of Queensland Brisbane 4072 Australia
| | - Fiona Harden
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- Hunter Industrial Medicine Maitland 2320 Australia
| | - Kerrie Mengersen
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
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Hargrave C, Deegan T, Poulsen M, Bednarz T, Harden F, Mengersen K. A feature alignment score for online cone‐beam
CT
‐based image‐guided radiotherapy for prostate cancer. Med Phys 2018; 45:2898-2911. [DOI: 10.1002/mp.12980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/22/2018] [Accepted: 04/14/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Catriona Hargrave
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- School of Clinical Sciences Faculty of Health Queensland University of Technology Brisbane 4000 Australia
| | - Timothy Deegan
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
| | - Michael Poulsen
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
- Faculty of Medicine University of Queensland Brisbane 4072 Australia
| | - Tomasz Bednarz
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- Data 61 Commonwealth Scientific and Industrial Research Organisation Brisbane 4102 Australia
- Expanded Perception and Interaction Centre University of New South Wales Paddington 2021 Australia
| | - Fiona Harden
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
| | - Kerrie Mengersen
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
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Abe Y, Kadoya N, Arai K, Takayama Y, Kato T, Kimura K, Ono T, Nakamura T, Wada H, Kikuchi Y, Jingu K. Effect of DIR uncertainty on prostate passive-scattering proton therapy dose accumulation. Phys Med 2017. [PMID: 28625473 DOI: 10.1016/j.ejmp.2017.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Branchini M, Fiorino C, Dell'Oca I, Belli M, Perna L, Di Muzio N, Calandrino R, Broggi S. Validation of a method for “dose of the day” calculation in head-neck tomotherapy by using planning ct-to-MVCT deformable image registration. Phys Med 2017; 39:73-79. [DOI: 10.1016/j.ejmp.2017.05.070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/29/2017] [Accepted: 05/28/2017] [Indexed: 01/25/2023] Open
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Takayama Y, Kadoya N, Yamamoto T, Ito K, Chiba M, Fujiwara K, Miyasaka Y, Dobashi S, Sato K, Takeda K, Jingu K. Evaluation of the performance of deformable image registration between planning CT and CBCT images for the pelvic region: comparison between hybrid and intensity-based DIR. JOURNAL OF RADIATION RESEARCH 2017; 58:567-571. [PMID: 28158642 PMCID: PMC5569957 DOI: 10.1093/jrr/rrw123] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/17/2016] [Indexed: 06/06/2023]
Abstract
This study aimed to evaluate the performance of the hybrid deformable image registration (DIR) method in comparison with intensity-based DIR for pelvic cone-beam computed tomography (CBCT) images, using intensity and anatomical information. Ten prostate cancer patients treated with intensity-modulated radiation therapy (IMRT) were studied. Nine or ten CBCT scans were performed for each patient. First, rigid registration was performed between the planning CT and all CBCT images using gold fiducial markers, and then DIR was performed. The Dice similarity coefficient (DSC) and center of mass (COM) displacement were used to evaluate the quantitative DIR accuracy. The average DSCs for intensity-based DIR for the prostate, rectum, bladder, and seminal vesicles were 0.84 ± 0.05, 0.75 ± 0.05, 0.69 ± 0.07 and 0.65 ± 0.11, respectively, whereas those values for hybrid DIR were 0.98 ± 0.00, 0.97 ± 0.01, 0.98 ± 0.00 and 0.94 ± 0.03, respectively (P < 0.05). The average COM displacements for intensity-based DIR for the prostate, rectum, bladder, and seminal vesicles were 2.0 ± 1.5, 3.7 ± 1.4, 7.8 ± 2.2 and 3.6 ± 1.2 mm, whereas those values for hybrid DIR were 0.1 ± 0.0, 0.3 ± 0.2, 0.2 ± 0.1 and 0.6 ± 0.6 mm, respectively (P < 0.05). These results showed that the DSC for hybrid DIR had a higher DSC value and smaller COM displacement for all structures and all patients, compared with intensity-based DIR. Thus, the accumulative dose based on hybrid DIR might be trusted as a high-precision dose estimation method that takes into account organ movement during treatment radiotherapy.
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Affiliation(s)
- Yoshiki Takayama
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Mizuki Chiba
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Kousei Fujiwara
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yuya Miyasaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Suguru Dobashi
- Department of Radiological Technology, Graduate School of Health Sciences, Faculty of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai 980-8574, Japan
| | - Kiyokazu Sato
- Radiation Technology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Ken Takeda
- Department of Radiological Technology, Graduate School of Health Sciences, Faculty of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Li X, Zhang YY, Shi YH, Zhou LH, Zhen X. Evaluation of deformable image registration for contour propagation between CT and cone-beam CT images in adaptive head and neck radiotherapy. Technol Health Care 2017; 24 Suppl 2:S747-55. [PMID: 27259084 DOI: 10.3233/thc-161204] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Deformable image registration (DIR) is a critical technic in adaptive radiotherapy (ART) to propagate contours between planning computerized tomography (CT) images and treatment CT/Cone-beam CT (CBCT) image to account for organ deformation for treatment re-planning. To validate the ability and accuracy of DIR algorithms in organ at risk (OAR) contours mapping, seven intensity-based DIR strategies are tested on the planning CT and weekly CBCT images from six Head & Neck cancer patients who underwent a 6 ∼ 7 weeks intensity-modulated radiation therapy (IMRT). Three similarity metrics, i.e. the Dice similarity coefficient (DSC), the percentage error (PE) and the Hausdorff distance (HD), are employed to measure the agreement between the propagated contours and the physician delineated ground truths. It is found that the performance of all the evaluated DIR algorithms declines as the treatment proceeds. No statistically significant performance difference is observed between different DIR algorithms (p> 0.05), except for the double force demons (DFD) which yields the worst result in terms of DSC and PE. For the metric HD, all the DIR algorithms behaved unsatisfactorily with no statistically significant performance difference (p= 0.273). These findings suggested that special care should be taken when utilizing the intensity-based DIR algorithms involved in this study to deform OAR contours between CT and CBCT, especially for those organs with low contrast.
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Affiliation(s)
- X Li
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Y Y Zhang
- Department of Radiotherapy Oncology, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Y H Shi
- Department of Radiotherapy Oncology, the First Hospital of Jilin University, Changchun, Jilin, China
| | - L H Zhou
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - X Zhen
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
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Fukumitsu N, Nitta K, Terunuma T, Okumura T, Numajiri H, Oshiro Y, Ohnishi K, Mizumoto M, Aihara T, Ishikawa H, Tsuboi K, Sakurai H. Registration error of the liver CT using deformable image registration of MIM Maestro and Velocity AI. BMC Med Imaging 2017; 17:30. [PMID: 28472925 PMCID: PMC5418691 DOI: 10.1186/s12880-017-0202-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the irradiated area and dose correctly is important for the reirradiation of organs that deform after irradiation, such as the liver. We investigated the spatial registration error using the deformable image registration (DIR) software products MIM Maestro (MIM) and Velocity AI (Velocity). METHODS Image registration of pretreatment computed tomography (CT) and posttreatment CT was performed in 24 patients with liver tumors. All the patients received proton beam therapy, and the follow-up period was 4-14 (median: 10) months. We performed DIR of the pretreatment CT and compared it with that of the posttreatment CT by calculating the dislocation of metallic markers (implanted close to the tumors). RESULTS The fiducial registration error was comparable in both products: 0.4-32.9 (9.3 ± 9.9) mm for MIM and 0.5-38.6 (11.0 ± 10.0) mm for Velocity, and correlated with the tumor diameter for MIM (r = 0.69, P = 0.002) and for Velocity (r = 0.68, P = 0.0003). Regarding the enhancement effect, the fiducial registration error was 1.0-24.9 (7.4 ± 7.7) mm for MIM and 0.3-29.6 (8.9 ± 7.2) mm for Velocity, which is shorter than that of plain CT (P = 0.04, for both). CONCLUSIONS The DIR performance of both MIM and Velocity is comparable with regard to the liver. The fiducial registration error of DIR depends on the tumor diameter. Furthermore, contrast-enhanced CT improves the accuracy of both MIM and Velocity. INSTITUTIONAL REVIEW BOARD APPROVAL H28-102; July 14, 2016 approved.
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Affiliation(s)
- Nobuyoshi Fukumitsu
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan.
| | - Kazunori Nitta
- Division of Radiology, Ibaraki Prefectural Central Hospital, 6528, Koibuchi, Kasama, Japan
| | - Toshiyuki Terunuma
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Toshiyuki Okumura
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Haruko Numajiri
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Yoshiko Oshiro
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Kayoko Ohnishi
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Masashi Mizumoto
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Teruhito Aihara
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Hitoshi Ishikawa
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Koji Tsuboi
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Hideyuki Sakurai
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
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Kadoya N, Miyasaka Y, Nakajima Y, Kuroda Y, Ito K, Chiba M, Sato K, Dobashi S, Yamamoto T, Takahashi N, Kubozono M, Takeda K, Jingu K. Evaluation of deformable image registration between external beam radiotherapy and HDR brachytherapy for cervical cancer with a 3D-printed deformable pelvis phantom. Med Phys 2017; 44:1445-1455. [PMID: 28214368 DOI: 10.1002/mp.12168] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 12/13/2016] [Accepted: 02/10/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In this study, we developed a 3D-printed deformable pelvis phantom for evaluating spatial DIR accuracy. We then evaluated the spatial DIR accuracies of various DIR settings for cervical cancer. METHODS A deformable female pelvis phantom was created based on patient CT data using 3D printing. To create the deformable uterus phantom, we first 3D printed both a model of uterus and a model of the internal cavities of the vagina and uterus. We then made a mold using the 3D printed uterus phantom. Finally, urethane was poured into the mold with the model of the internal cavities in place, creating the deformable uterus phantom with a cavity into which an applicator could be inserted. To create the deformable bladder phantom, we first 3D printed models of the bladder and of the same bladder scaled down by 2 mm. We then made a mold using the larger bladder model. Finally, silicone was poured into the mold with the smaller bladder model in place to create the deformable bladder phantom with a wall thickness of 2 mm. To emulate the anatomical bladder, water was poured into the created bladder. We acquired phantom image without applicator for EBRT. Then, we inserted the applicator into the phantom to simulate BT. In this situation, we scanned the phantom again to obtain the phantom image for BT. We performed DIR using the two phantom images in two cases: Case A, with full bladder (170 ml) in both EBRT and BT images; and Case B with full bladder in the BT image and half-full bladder (100 ml) in the EBRT image. DIR was evaluated using Dice similarity coefficients (DSCs) and 31 landmarks for the uterus and 25 landmarks for the bladder. A hybrid intensity and structure DIR algorithm implemented in RayStation with four DIR settings was evaluated. RESULTS On visual inspection, reasonable agreement in shape of the uterus between the phantom and patient CT images was observed for both EBRT and BT, although some regional disagreements in shape of the bladder and rectum were apparent. The created phantom could reproduce the actual patient's uterus deformation by the applicator. For both Case A and B, large variation was seen in landmark error among the four DIR parameters. In addition, although DSCs were comparable, moderate differences in landmark error existed between the two different DIR parameters selected from the four DIR parameters (i.e., DSC = 0.96, landmark error = 13.2 ± 5.7 mm vs. DSC = 0.97, landmark error = 9.7 ± 4.0 mm). This result suggests that landmark error evaluation might thus be more effective than DSC for evaluating DIR accuracy. CONCLUSIONS Our developed phantom enabled the evaluation of spatial DIR accuracy for the female pelvic region for the first time. Although the DSCs are high, the spatial errors can still be significant and our developed phantom facilitates their quantification. Our results showed that optimization is needed to identify suitable DIR settings. For determining suitable DIR settings, our method of evaluating spatial DIR accuracy using the 3D-printed phantom may prove helpful.
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Affiliation(s)
- Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Yuya Miyasaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Yujiro Nakajima
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Yoshihiro Kuroda
- Department of Bioengineering, Graduate School of Engineering Science, Osaka University, Osaka, 565-0871, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Mizuki Chiba
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Kiyokazu Sato
- Department of Radiology, Tohoku University Hospital, Sendai, 980-8574, Japan
| | - Suguru Dobashi
- Department of Therapeutic Radiology, Tohoku University School of Medicine, Miyagi, 980-8574, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Masaki Kubozono
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Ken Takeda
- Department of Therapeutic Radiology, Tohoku University School of Medicine, Miyagi, 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
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Li X, Zhang Y, Shi Y, Wu S, Xiao Y, Gu X, Zhen X, Zhou L. Comprehensive evaluation of ten deformable image registration algorithms for contour propagation between CT and cone-beam CT images in adaptive head & neck radiotherapy. PLoS One 2017; 12:e0175906. [PMID: 28414799 PMCID: PMC5393623 DOI: 10.1371/journal.pone.0175906] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 04/02/2017] [Indexed: 01/16/2023] Open
Abstract
Deformable image registration (DIR) is a critical technic in adaptive radiotherapy (ART) for propagating contours between planning computerized tomography (CT) images and treatment CT/cone-beam CT (CBCT) images to account for organ deformation for treatment re-planning. To validate the ability and accuracy of DIR algorithms in organ at risk (OAR) contour mapping, ten intensity-based DIR strategies, which were classified into four categories—optical flow-based, demons-based, level-set-based and spline-based—were tested on planning CT and fractional CBCT images acquired from twenty-one head & neck (H&N) cancer patients who underwent 6~7-week intensity-modulated radiation therapy (IMRT). Three similarity metrics, i.e., the Dice similarity coefficient (DSC), the percentage error (PE) and the Hausdorff distance (HD), were employed to measure the agreement between the propagated contours and the physician-delineated ground truths of four OARs, including the vertebra (VTB), the vertebral foramen (VF), the parotid gland (PG) and the submandibular gland (SMG). It was found that the evaluated DIRs in this work did not necessarily outperform rigid registration. DIR performed better for bony structures than soft-tissue organs, and the DIR performance tended to vary for different ROIs with different degrees of deformation as the treatment proceeded. Generally, the optical flow-based DIR performed best, while the demons-based DIR usually ranked last except for a modified demons-based DISC used for CT-CBCT DIR. These experimental results suggest that the choice of a specific DIR algorithm depends on the image modality, anatomic site, magnitude of deformation and application. Therefore, careful examinations and modifications are required before accepting the auto-propagated contours, especially for automatic re-planning ART systems.
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Affiliation(s)
- Xin Li
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuyu Zhang
- Department of Radiotherapy Oncology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yinghua Shi
- Department of Radiotherapy Oncology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Shuyu Wu
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Yang Xiao
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Xuejun Gu
- Department of Radiotherapy Oncology, The University of Texas, Southwestern Medical Center, Dallas, Texas, United States of America
| | - Xin Zhen
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
- * E-mail: (XZ); (LZ)
| | - Linghong Zhou
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
- * E-mail: (XZ); (LZ)
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Santoso AP, Song KH, Qin Y, Gardner SJ, Liu C, Chetty IJ, Movsas B, Ajlouni M, Wen N. Evaluation of gantry speed on image quality and imaging dose for 4D cone-beam CT acquisition. Radiat Oncol 2016; 11:98. [PMID: 27473367 PMCID: PMC4966562 DOI: 10.1186/s13014-016-0677-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background This study investigates the effect of gantry speed on 4DCBCT image quality and dose for the Varian On-Board Imager®. Methods A thoracic 4DCBCT protocol was designed using a 125 kVp spectrum. Image quality parameters were evaluated for 4DCBCT acquisition using Catphan® phantom with real-time position management™ system for gantry speeds varying between 1.0 to 6.0°/s. Superior-inferior motion of the phantom was executed using a sinusoidal waveform with five second period. Scans were retrospectively sorted into 4 phases (CBCT-4 ph) and 10 phases (CBCT-10 ph); average 4DCBCT (CBCT-ave), using all image data from the 4DCBCT acquisitions was also evaluated. The 4DCBCT images were evaluated using the following image quality metrics: spatial resolution, contrast-to-noise ratio (CNR), and uniformity index (UI). Additionally, Hounsfield unit (HU) sensitivity compared to a baseline CBCT and percent differences and RMS errors (RMSE) of excursion were also determined. Imaging dose was evaluated using an IBA CC13 ion chamber placed within CIRS Thorax phantom using the same sinusoidal motion and image acquisition settings as mentioned above. Results Spatial resolution decreased linearly from 5.93 to 3.82 lp/cm as gantry speed increased from 1.0 to 6.0°/s. CNR decreased linearly from 4.80 to 1.82 with gantry speed increasing from 1.0 to 6.0°/s, respectively. No noteworthy variations in UI, HU sensitivity, or excursion metrics were observed with changes in gantry speed. Ion chamber dose rates measured ranged from 2.30 (lung) to 5.18 (bone) E-3 cGy/mAs. Conclusions A quantitative analysis of the Varian OBI’s 4DCBCT capabilities was explored. Changing gantry speed changes the number of projections used for reconstruction, affecting both image quality and imaging dose if x-ray tube current is held constant. From the results of this study, a gantry speed between 2 and 3°/s was optimal when considering image quality, dose, and reconstruction time. The future of 4DCBCT clinical utility relies on further investigation of image acquisition and reconstruction optimization.
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Affiliation(s)
- Andrew P Santoso
- Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Kwang H Song
- Texas Oncology, Fort Worth, TX, 76104, USA.,Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Yujiao Qin
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Stephen J Gardner
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Chang Liu
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Munther Ajlouni
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA.
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Huang Y, Gardner SJ, Wen N, Zhao B, Gordon J, Brown S, Chetty IJ. Radiobiologically optimized couch shift: A new localization paradigm using cone-beam CT for prostate radiotherapy. Med Phys 2016; 42:6028-32. [PMID: 26429278 DOI: 10.1118/1.4931450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To present a novel positioning strategy which optimizes radiation delivery by utilizing radiobiological response knowledge and evaluate its use during prostate external beam radiotherapy. METHODS Five patients with low or intermediate risk prostate cancer were evaluated retrospectively in this IRB-approved study. For each patient, a VMAT plan with one 358° arc was generated on the planning CT (PCT) to deliver 78 Gy in 39 fractions. Five representative pretreatment cone beam CTs (CBCT) were selected for each patient. The CBCT images were registered to PCT by a human observer, which consisted of an initial automated registration with three degrees-of-freedom, followed by manual adjustment for agreement at the prostate/rectal wall interface. To determine the optimal treatment position for each CBCT, a search was performed centering on the observer-matched position (OM-position) utilizing a score function based on radiobiological and dosimetric indices (EUDprostate, D99prostate, NTCPrectum, and NTCPbladder) for the prostate, rectum, and bladder. We termed the optimal treatment position the radiobiologically optimized couch shift position (ROCS-position). RESULTS The dosimetric indices, averaged over the five patients' treatment plans, were (mean ± SD) 79.5 ± 0.3 Gy (EUDprostate), 78.2 ± 0.4 Gy (D99prostate), 11.1% ± 2.7% (NTCPrectum), and 46.9% ± 7.6% (NTCPbladder). The corresponding values from CBCT at the OM-positions were 79.5 ± 0.6 Gy (EUDprostate), 77.8 ± 0.7 Gy (D99prostate), 12.1% ± 5.6% (NTCPrectum), and 51.6% ± 15.2% (NTCPbladder), respectively. In comparison, from CBCT at the ROCS-positions, the dosimetric indices were 79.5 ± 0.6 Gy (EUDprostate), 77.3 ± 0.6 Gy (D99prostate), 8.0% ± 3.3% (NTCPrectum), and 46.9% ± 15.7% (NTCPbladder). Excessive NTCPrectum was observed on Patient 5 (19.5% ± 6.6%) corresponding to localization at OM-position, compared to the planned value of 11.7%. This was mitigated with radiobiologically optimized localization, resulting in a reduced NTCPrectum value of 11.3% ± 3.5%. Overall, the treatment position optimization resulted in similar target dose coverage with reduced risk to rectum. CONCLUSIONS These encouraging results illustrate the potential advantage of applying radiobiologically optimized correction for online image-guided radiotherapy of prostate patients.
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Affiliation(s)
- Yimei Huang
- Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
| | - Stephen J Gardner
- Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
| | - Bo Zhao
- Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
| | - James Gordon
- Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
| | - Stephen Brown
- Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
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Yi J, Yang X, Chen G, Li YR. Lung motion estimation using dynamic point shifting: An innovative model based on a robust point matching algorithm. Med Phys 2016; 42:5616-32. [PMID: 26429236 DOI: 10.1118/1.4929556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Image-guided radiotherapy is an advanced 4D radiotherapy technique that has been developed in recent years. However, respiratory motion causes significant uncertainties in image-guided radiotherapy procedures. To address these issues, an innovative lung motion estimation model based on a robust point matching is proposed in this paper. METHODS An innovative robust point matching algorithm using dynamic point shifting is proposed to estimate patient-specific lung motion during free breathing from 4D computed tomography data. The correspondence of the landmark points is determined from the Euclidean distance between the landmark points and the similarity between the local images that are centered at points at the same time. To ensure that the points in the source image correspond to the points in the target image during other phases, the virtual target points are first created and shifted based on the similarity between the local image centered at the source point and the local image centered at the virtual target point. Second, the target points are shifted by the constrained inverse function mapping the target points to the virtual target points. The source point set and shifted target point set are used to estimate the transformation function between the source image and target image. RESULTS The performances of the authors' method are evaluated on two publicly available DIR-lab and POPI-model lung datasets. For computing target registration errors on 750 landmark points in six phases of the DIR-lab dataset and 37 landmark points in ten phases of the POPI-model dataset, the mean and standard deviation by the authors' method are 1.11 and 1.11 mm, but they are 2.33 and 2.32 mm without considering image intensity, and 1.17 and 1.19 mm with sliding conditions. For the two phases of maximum inhalation and maximum exhalation in the DIR-lab dataset with 300 landmark points of each case, the mean and standard deviation of target registration errors on the 3000 landmark points of ten cases by the authors' method are 1.21 and 1.04 mm. In the EMPIRE10 lung registration challenge, the authors' method ranks 24 of 39. According to the index of the maximum shear stretch, the authors' method is also efficient to describe the discontinuous motion at the lung boundaries. CONCLUSIONS By establishing the correspondence of the landmark points in the source phase and the other target phases combining shape matching and image intensity matching together, the mismatching issue in the robust point matching algorithm is adequately addressed. The target registration errors are statistically reduced by shifting the virtual target points and target points. The authors' method with consideration of sliding conditions can effectively estimate the discontinuous motion, and the estimated motion is natural. The primary limitation of the proposed method is that the temporal constraints of the trajectories of voxels are not introduced into the motion model. However, the proposed method provides satisfactory motion information, which results in precise tumor coverage by the radiation dose during radiotherapy.
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Affiliation(s)
- Jianbing Yi
- College of Information Engineering, Shenzhen University, Shenzhen, Guangdong 518000, China and College of Information Engineering, Jiangxi University of Science and Technology, Ganzhou, Jiangxi 341000, China
| | - Xuan Yang
- College of Computer Science and Software Engineering, Shenzhen University, Shenzhen, Guangdong 518000, China
| | - Guoliang Chen
- National High Performance Computing Center at Shenzhen, College of Computer Science and Software Engineering, Shenzhen University, Shenzhen, Guangdong 518000, China
| | - Yan-Ran Li
- College of Computer Science and Software Engineering, Shenzhen University, Shenzhen, Guangdong 518000, China
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Zhang Y, Yin FF, Ren L. Dosimetric verification of lung cancer treatment using the CBCTs estimated from limited-angle on-board projections. Med Phys 2016; 42:4783-95. [PMID: 26233206 DOI: 10.1118/1.4926559] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Lung cancer treatment is susceptible to treatment errors caused by interfractional anatomical and respirational variations of the patient. On-board treatment dose verification is especially critical for the lung stereotactic body radiation therapy due to its high fractional dose. This study investigates the feasibility of using cone-beam (CB)CT images estimated by a motion modeling and free-form deformation (MM-FD) technique for on-board dose verification. METHODS Both digital and physical phantom studies were performed. Various interfractional variations featuring patient motion pattern change, tumor size change, and tumor average position change were simulated from planning CT to on-board images. The doses calculated on the planning CT (planned doses), the on-board CBCT estimated by MM-FD (MM-FD doses), and the on-board CBCT reconstructed by the conventional Feldkamp-Davis-Kress (FDK) algorithm (FDK doses) were compared to the on-board dose calculated on the "gold-standard" on-board images (gold-standard doses). The absolute deviations of minimum dose (ΔDmin), maximum dose (ΔDmax), and mean dose (ΔDmean), and the absolute deviations of prescription dose coverage (ΔV100%) were evaluated for the planning target volume (PTV). In addition, 4D on-board treatment dose accumulations were performed using 4D-CBCT images estimated by MM-FD in the physical phantom study. The accumulated doses were compared to those measured using optically stimulated luminescence (OSL) detectors and radiochromic films. RESULTS Compared with the planned doses and the FDK doses, the MM-FD doses matched much better with the gold-standard doses. For the digital phantom study, the average (± standard deviation) ΔDmin, ΔDmax, ΔDmean, and ΔV100% (values normalized by the prescription dose or the total PTV) between the planned and the gold-standard PTV doses were 32.9% (±28.6%), 3.0% (±2.9%), 3.8% (±4.0%), and 15.4% (±12.4%), respectively. The corresponding values of FDK PTV doses were 1.6% (±1.9%), 1.2% (±0.6%), 2.2% (±0.8%), and 17.4% (±15.3%), respectively. In contrast, the corresponding values of MM-FD PTV doses were 0.3% (±0.2%), 0.9% (±0.6%), 0.6% (±0.4%), and 1.0% (±0.8%), respectively. Similarly, for the physical phantom study, the average ΔDmin, ΔDmax, ΔDmean, and ΔV100% of planned PTV doses were 38.1% (±30.8%), 3.5% (±5.1%), 3.0% (±2.6%), and 8.8% (±8.0%), respectively. The corresponding values of FDK PTV doses were 5.8% (±4.5%), 1.6% (±1.6%), 2.0% (±0.9%), and 9.3% (±10.5%), respectively. In contrast, the corresponding values of MM-FD PTV doses were 0.4% (±0.8%), 0.8% (±1.0%), 0.5% (±0.4%), and 0.8% (±0.8%), respectively. For the 4D dose accumulation study, the average (± standard deviation) absolute dose deviation (normalized by local doses) between the accumulated doses and the OSL measured doses was 3.3% (±2.7%). The average gamma index (3%/3 mm) between the accumulated doses and the radiochromic film measured doses was 94.5% (±2.5%). CONCLUSIONS MM-FD estimated 4D-CBCT enables accurate on-board dose calculation and accumulation for lung radiation therapy. It can potentially be valuable for treatment quality assessment and adaptive radiation therapy.
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Affiliation(s)
- You Zhang
- Medical Physics Graduate Program, Duke University, Durham, North Carolina 27710
| | - Fang-Fang Yin
- Medical Physics Graduate Program, Duke University, Durham, North Carolina 27710 and Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710
| | - Lei Ren
- Medical Physics Graduate Program, Duke University, Durham, North Carolina 27710 and Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710
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Rosewall T, Wheat J, Currie G, Kong V, Bayley AJ, Moseley J, Chung P, Catton C, Craig T, Milosevic M. Planned versus 'delivered' bladder dose reconstructed using solid and hollow organ models during prostate cancer IMRT. Radiother Oncol 2016; 119:417-22. [PMID: 27072936 DOI: 10.1016/j.radonc.2016.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/11/2016] [Accepted: 03/13/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE All studies to date have evaluated the dosimetric effect of bladder deformation using an organ model that includes the dose to the urine. This research reconstructed bladder dose using both hollow and solid organ models, to determine if dose/volume differences exist. MATERIALS AND METHODS 35 prostate IMRT patients were selected, who had received 78Gy in 39 fractions and full bladder instructions. Biomechanical modelling and finite element analysis were used to reconstruct bladder dose (solid and hollow organ model) using every third CBCT throughout the treatment course. RESULTS Reconstructed dose (ReconDose) was 11.3Gy greater than planned dose (planDose) with a hollow bladder model (p<0.001) and 12.3Gy greater with a solid bladder model (p<0.0001). Median reconstructed volumes within the 30Gy, 65Gy and 78Gy isodoses were 3-4 times larger with the solid organ model (p<0.0001). The difference between planning bladder volume and median treatment volume was associated with the difference between the planDose and reconDose below 78Gy (R(2)>0.61). CONCLUSIONS Substantial differences exist between planned and reconstructed bladder dose, associated with the differences in bladder filling between planning and treatment. Dose reconstructed using a solid bladder model over-reports the volume of bladder within key isodose levels and overestimates the differences between planned and reconstructed dose. Dose reconstruction with a hollow organ model is recommended if the goal is to associate that dose with toxicity.
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Affiliation(s)
- Tara Rosewall
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada; Faculty of Science, Charles Sturt University, Australia.
| | - Janelle Wheat
- Faculty of Science, Charles Sturt University, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Australia
| | - Geoffrey Currie
- Faculty of Science, Charles Sturt University, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Australia
| | - Vickie Kong
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Andrew J Bayley
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Joanne Moseley
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Charles Catton
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Tim Craig
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Michael Milosevic
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
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Nassef M, Simon A, Cazoulat G, Duménil A, Blay C, Lafond C, Acosta O, Balosso J, Haigron P, de Crevoisier R. Quantification of dose uncertainties in cumulated dose estimation compared to planned dose in prostate IMRT. Radiother Oncol 2016; 119:129-36. [DOI: 10.1016/j.radonc.2016.03.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 03/02/2016] [Accepted: 03/02/2016] [Indexed: 12/25/2022]
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Analysis of nodal coverage utilizing image guided radiation therapy for primary gynecologic tumor volumes. Med Dosim 2016; 41:195-8. [DOI: 10.1016/j.meddos.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 12/04/2015] [Accepted: 12/29/2015] [Indexed: 11/30/2022]
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A Prospective Comparison of the Effects of Interfractional Variations on Proton Therapy and Intensity Modulated Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2015; 95:444-453. [PMID: 26907917 DOI: 10.1016/j.ijrobp.2015.12.366] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/24/2015] [Accepted: 12/21/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE To quantify and compare the impact of interfractional setup and anatomic variations on proton therapy (PT) and intensity modulated radiation therapy (IMRT) for prostate cancer. METHODS AND MATERIALS Twenty patients with low-risk or intermediate-risk prostate cancer randomized to receive passive-scattering PT (n=10) and IMRT (n=10) were selected. For both modalities, clinical treatment plans included 50.4 Gy(RBE) to prostate and proximal seminal vesicles, and prostate-only boost to 79.2 Gy(RBE) in 1.8 Gy(RBE) per fraction. Implanted fiducials were used for prostate localization and endorectal balloons were used for immobilization. Patients in PT and IMRT arms received weekly computed tomography (CT) and cone beam CT (CBCT) scans, respectively. The planned dose was recalculated on each weekly image, scaled, and mapped onto the planning CT using deformable registration. The resulting accumulated dose distribution over the entire treatment course was compared with the planned dose using dose-volume histogram (DVH) and γ analysis. RESULTS The target conformity index remained acceptable after accumulation. The largest decrease in the average prostate D98 was 2.2 and 0.7 Gy for PT and IMRT, respectively. On average, the mean dose to bladder increased by 3.26 ± 7.51 Gy and 1.97 ± 6.84 Gy for PT and IMRT, respectively. These values were 0.74 ± 2.37 and 0.56 ± 1.90 for rectum. Differences between changes in DVH indices were not statistically significant between modalities. All volume indices remained within the protocol tolerances after accumulation. The average pass rate for the γ analysis, assuming tolerances of 3 mm and 3%, for clinical target volume, bladder, rectum, and whole patient for PT/IMRT were 100/100, 92.6/99, 99.2/100, and 97.2/99.4, respectively. CONCLUSION The differences in target coverage and organs at risk dose deviations for PT and IMRT were not statistically significant under the guidelines of this protocol.
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Cantin A, Gingras L, Lachance B, Foster W, Goudreault J, Archambault L. Dosimetric evaluation of three adaptive strategies for prostate cancer treatment including pelvic lymph nodes irradiation. Med Phys 2015; 42:7011-21. [DOI: 10.1118/1.4935529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Mayyas E, Kim J, Kumar S, Liu C, Wen N, Movsas B, Elshaikh MA, Chetty IJ. A novel approach for evaluation of prostate deformation and associated dosimetric implications in IGRT of the prostate. Med Phys 2015; 41:091709. [PMID: 25186384 DOI: 10.1118/1.4893196] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Prostate deformation is assumed to be a secondary correction and is typically ignored in the planning target volume (PTV) margin calculations. This assumption needs to be tested, especially when planning margins are reduced with daily image-guidance. In this study, deformation characteristics of the prostate and seminal vesicles were determined, and the dosimetric impact on treatment plans with different PTV margins was investigated. METHODS Ten prostate cancer patients were retrospectively selected for the study, each with three fiducial markers implanted in the prostate. Two hundred CBCT images were registered to respective planning CT images using a B-spline-based deformable image registration (DIR) software. A manual bony anatomy-based match was first applied based on the alignment of the pelvic bones and fiducial landmarks. DIR was then performed. For each registration, deformation vector fields (DVFs) of the prostate and seminal vesicles (SVs) were quantified using deformation-volume histograms. In addition, prostate rotation was evaluated and compared with prostate deformation. For a patient demonstrating small and large prostate deformations, target coverage degradation was analyzed in each of three treatment plans with PTV margins of 10 mm (6 mm at the prostate/rectum interface), as well as 5, and 3 mm uniformly. RESULTS Deformation of the prostate was most significant in the anterior direction. Maximum prostate deformation of greater than 10, 5, and 3 mm occurred in 1%, 17%, and 76% of the cases, respectively. Based on DVF-histograms, DVF magnitudes greater than 5 and 3 mm occurred in 2% and 27% of the cases, respectively. Deformation of the SVs was most significant in the posterior direction, and it was greater than 5 and 3 mm in 7.5% and 44.9% of the cases, respectively. Prostate deformation was found to be poorly correlated with rotation. Fifty percent of the cases showed rotation with negligible deformation and 7% of the cases showed significant deformation with minimal rotation (<3°). Average differences in the D95 dose to the prostate+SVs between the planning CT and CBCT images was 0.4%±0.5%, 3.0%±2.8%, and 6.6%±6.1%, respectively, for the plans with 10/6, 5, and 3 mm margins. For the case with both a large degree of prostate deformation (≈10% of the prostate volume) and rotation (≈8°), D95 was reduced by 0.5%±0.1%, 6.8%±0.6%, and 20.9%±1.6% for 10/6, 5, and 3 mm margin plans, respectively. For the case with large prostate deformation but negligible rotation (<1°), D95 was reduced by 0.4±0.3, 3.9±1.0, and 11.5±2.5 for 10/6, 5, and 3 mm margin plans, respectively. CONCLUSIONS Prostate deformation over a course of fractionated prostate radiotherapy may not be insignificant and may need to be accounted for in the planning margin design. A consequence of these results is that use of highly reduced planning margins must be viewed with caution.
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Affiliation(s)
- Essa Mayyas
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, Michigan 48202
| | - Jinkoo Kim
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, Michigan 48202
| | - Sanath Kumar
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, Michigan 48202
| | - Chang Liu
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, Michigan 48202
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, Michigan 48202
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, Michigan 48202
| | - Mohamed A Elshaikh
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, Michigan 48202
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, Michigan 48202
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Glide-Hurst CK, Wen N, Hearshen D, Kim J, Pantelic M, Zhao B, Mancell T, Levin K, Movsas B, Chetty IJ, Siddiqui MS. Initial clinical experience with a radiation oncology dedicated open 1.0T MR-simulation. J Appl Clin Med Phys 2015; 16:5201. [PMID: 26103190 PMCID: PMC5690096 DOI: 10.1120/jacmp.v16i2.5201] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/10/2014] [Accepted: 12/10/2014] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to describe our experience with 1.0T MR-SIM including characterization, quality assurance (QA) program, and features necessary for treatment planning. Staffing, safety, and patient screening procedures were developed. Utilization of an external laser positioning system (ELPS) and MR-compatible couchtop were illustrated. Spatial and volumetric analyses were conducted between CT-SIM and MR-SIM using a stereotactic QA phantom with known landmarks and volumes. Magnetic field inhomogeneity was determined using phase difference analysis. System-related, in-plane distortion was evaluated and temporal changes were assessed. 3D distortion was characterized for regions of interest (ROIs) 5-20 cm away from isocenter. American College of Radiology (ACR) recommended tests and impact of ELPS on image quality were analyzed. Combined ultrashort echotime Dixon (UTE/Dixon) sequence was evaluated. Amplitude-triggered 4D MRI was implemented using a motion phantom (2-10 phases, ~ 2 cm excursion, 3-5 s periods) and a liver cancer patient. Duty cycle, acquisition time, and excursion were evaluated between maximum intensity projection (MIP) datasets. Less than 2% difference from expected was obtained between CT-SIM and MR-SIM volumes, with a mean distance of < 0.2 mm between landmarks. Magnetic field inhomogeneity was < 2 ppm. 2D distortion was < 2 mm over 28.6-33.6 mm of isocenter. Within 5 cm radius of isocenter, mean 3D geometric distortion was 0.59 ± 0.32 mm (maximum = 1.65 mm) and increased 10-15 cm from isocenter (mean = 1.57 ± 1.06 mm, maximum = 6.26 mm). ELPS interference was within the operating frequency of the scanner and was characterized by line patterns and a reduction in signal-to-noise ratio (4.6-12.6% for TE = 50-150 ms). Image quality checks were within ACR recommendations. UTE/Dixon sequences yielded detectability between bone and air. For 4D MRI, faster breathing periods had higher duty cycles than slow (50.4% (3 s) and 39.4% (5 s), p < 0.001) and ~fourfold acquisition time increase was measured for ten-phase versus two-phase. Superior-inferior object extent was underestimated 8% (6 mm) for two-phase as compared to ten-phase MIPs, although < 2% difference was obtained for ≥ 4 phases. 4D MRI for a patient demonstrated acceptable image quality in ~ 7 min. MR-SIM was integrated into our workflow and QA procedures were developed. Clinical applicability was demonstrated for 4D MRI and UTE imaging to support MR-SIM for single modality treatment planning.
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Wognum S, Heethuis SE, Rosario T, Hoogeman MS, Bel A. Validation of deformable image registration algorithms on CT images ofex vivoporcine bladders with fiducial markers. Med Phys 2014; 41:071916. [PMID: 24989394 DOI: 10.1118/1.4883839] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- S Wognum
- Department of Radiation Oncology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - S E Heethuis
- Department of Radiation Oncology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - T Rosario
- Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - M S Hoogeman
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Erasmus Medical Center, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
| | - A Bel
- Department of Radiation Oncology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Glide-Hurst CK, Chetty IJ. Improving radiotherapy planning, delivery accuracy, and normal tissue sparing using cutting edge technologies. J Thorac Dis 2014; 6:303-18. [PMID: 24688775 PMCID: PMC3968554 DOI: 10.3978/j.issn.2072-1439.2013.11.10] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/07/2013] [Indexed: 12/25/2022]
Abstract
In the United States, more than half of all new invasive cancers diagnosed are non-small cell lung cancer, with a significant number of these cases presenting at locally advanced stages, resulting in about one-third of all cancer deaths. While the advent of stereotactic ablative radiation therapy (SABR, also known as stereotactic body radiotherapy, or SBRT) for early-staged patients has improved local tumor control to >90%, survival results for locally advanced stage lung cancer remain grim. Significant challenges exist in lung cancer radiation therapy including tumor motion, accurate dose calculation in low density media, limiting dose to nearby organs at risk, and changing anatomy over the treatment course. However, many recent technological advancements have been introduced that can meet these challenges, including four-dimensional computed tomography (4DCT) and volumetric cone-beam computed tomography (CBCT) to enable more accurate target definition and precise tumor localization during radiation, respectively. In addition, advances in dose calculation algorithms have allowed for more accurate dosimetry in heterogeneous media, and intensity modulated and arc delivery techniques can help spare organs at risk. New delivery approaches, such as tumor tracking and gating, offer additional potential for further reducing target margins. Image-guided adaptive radiation therapy (IGART) introduces the potential for individualized plan adaptation based on imaging feedback, including bulky residual disease, tumor progression, and physiological changes that occur during the treatment course. This review provides an overview of the current state of the art technology for lung cancer volume definition, treatment planning, localization, and treatment plan adaptation.
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Akino Y, Yoshioka Y, Fukuda S, Maruoka S, Takahashi Y, Yagi M, Mizuno H, Isohashi F, Ogawa K. Estimation of rectal dose using daily megavoltage cone-beam computed tomography and deformable image registration. Int J Radiat Oncol Biol Phys 2013; 87:602-8. [PMID: 24074934 DOI: 10.1016/j.ijrobp.2013.06.2054] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/19/2013] [Accepted: 06/22/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The actual dose delivered to critical organs will differ from the simulated dose because of interfractional organ motion and deformation. Here, we developed a method to estimate the rectal dose in prostate intensity modulated radiation therapy with consideration to interfractional organ motion using daily megavoltage cone-beam computed tomography (MVCBCT). METHODS AND MATERIALS Under exemption status from our institutional review board, we retrospectively reviewed 231 series of MVCBCT of 8 patients with prostate cancer. On both planning CT (pCT) and MVCBCT images, the rectal contours were delineated and the CT value within the contours was replaced by the mean CT value within the pelvis, with the addition of 100 Hounsfield units. MVCBCT images were rigidly registered to pCT and then nonrigidly registered using B-Spline deformable image registration (DIR) with Velocity AI software. The concordance between the rectal contours on MVCBCT and pCT was evaluated using the Dice similarity coefficient (DSC). The dose distributions normalized for 1 fraction were also deformed and summed to estimate the actual total dose. RESULTS The DSC of all treatment fractions of 8 patients was improved from 0.75±0.04 (mean ±SD) to 0.90 ±0.02 by DIR. Six patients showed a decrease of the generalized equivalent uniform dose (gEUD) from total dose compared with treatment plans. Although the rectal volume of each treatment fraction did not show any correlation with the change in gEUD (R(2)=0.18±0.13), the displacement of the center of gravity of rectal contours in the anterior-posterior (AP) direction showed an intermediate relationship (R(2)=0.61±0.16). CONCLUSION We developed a method for evaluation of rectal dose using DIR and MVCBCT images and showed the necessity of DIR for the evaluation of total dose. Displacement of the rectum in the AP direction showed a greater effect on the change in rectal dose compared with the rectal volume.
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Affiliation(s)
- Yuichi Akino
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Radiology, Osaka University Hospital, Suita, Osaka, Japan.
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Wen N, Kumarasiri A, Nurushev T, Burmeister J, Xing L, Liu D, Glide-Hurst C, Kim J, Zhong H, Movsas B, Chetty IJ. An assessment of PTV margin based on actual accumulated dose for prostate cancer radiotherapy. Phys Med Biol 2013; 58:7733-44. [PMID: 24140847 DOI: 10.1088/0031-9155/58/21/7733] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The purpose of this work is to present the results of a margin reduction study involving dosimetric and radiobiologic assessment of cumulative dose distributions, computed using an image guided adaptive radiotherapy based framework. Eight prostate cancer patients, treated with 7-9, 6 MV, intensity modulated radiation therapy (IMRT) fields, were included in this study. The workflow consists of cone beam CT (CBCT) based localization, deformable image registration of the CBCT to simulation CT image datasets (SIM-CT), dose reconstruction and dose accumulation on the SIM-CT, and plan evaluation using radiobiological models. For each patient, three IMRT plans were generated with different margins applied to the CTV. The PTV margin for the original plan was 10 mm and 6 mm at the prostate/anterior rectal wall interface (10/6 mm) and was reduced to: (a) 5/3 mm, and (b) 3 mm uniformly. The average percent reductions in predicted tumor control probability (TCP) in the accumulated (actual) plans in comparison to the original plans over eight patients were 0.4%, 0.7% and 11.0% with 10/6 mm, 5/3 mm and 3 mm uniform margin respectively. The mean increase in predicted normal tissue complication probability (NTCP) for grades 2/3 rectal bleeding for the actual plans in comparison to the static plans with margins of 10/6, 5/3 and 3 mm uniformly was 3.5%, 2.8% and 2.4% respectively. For the actual dose distributions, predicted NTCP for late rectal bleeding was reduced by 3.6% on average when the margin was reduced from 10/6 mm to 5/3 mm, and further reduced by 1.0% on average when the margin was reduced to 3 mm. The average reduction in complication free tumor control probability (P+) in the actual plans in comparison to the original plans with margins of 10/6, 5/3 and 3 mm was 3.7%, 2.4% and 13.6% correspondingly. The significant reduction of TCP and P+ in the actual plan with 3 mm margin came from one outlier, where individualizing patient treatment plans through margin adaptation based on biological models, might yield higher quality treatments.
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Affiliation(s)
- Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI 48202, USA
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Fabri D, Zambrano V, Bhatia A, Furtado H, Bergmann H, Stock M, Bloch C, Lütgendorf-Caucig C, Pawiro S, Georg D, Birkfellner W, Figl M. A quantitative comparison of the performance of three deformable registration algorithms in radiotherapy. Z Med Phys 2013; 23:279-90. [PMID: 23969092 PMCID: PMC3865361 DOI: 10.1016/j.zemedi.2013.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 07/24/2013] [Accepted: 07/25/2013] [Indexed: 11/17/2022]
Abstract
We present an evaluation of various non-rigid registration algorithms for the purpose of compensating interfractional motion of the target volume and organs at risk areas when acquiring CBCT image data prior to irradiation. Three different deformable registration (DR) methods were used: the Demons algorithm implemented in the iPlan Software (BrainLAB AG, Feldkirchen, Germany) and two custom-developed piecewise methods using either a Normalized Correlation or a Mutual Information metric (featureletNC and featureletMI). These methods were tested on data acquired using a novel purpose-built phantom for deformable registration and clinical CT/CBCT data of prostate and lung cancer patients. The Dice similarity coefficient (DSC) between manually drawn contours and the contours generated by a derived deformation field of the structures in question was compared to the result obtained with rigid registration (RR). For the phantom, the piecewise methods were slightly superior, the featureletNC for the intramodality and the featureletMI for the intermodality registrations. For the prostate cases in less than 50% of the images studied the DSC was improved over RR. Deformable registration methods improved the outcome over a rigid registration for lung cases and in the phantom study, but not in a significant way for the prostate study. A significantly superior deformation method could not be identified.
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Affiliation(s)
- Daniella Fabri
- Center of Medical Physics and Biomedical Engineering, Medical University of Vienna, AKH-4L, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Tilly D, Tilly N, Ahnesjö A. Dose mapping sensitivity to deformable registration uncertainties in fractionated radiotherapy - applied to prostate proton treatments. BMC MEDICAL PHYSICS 2013; 13:2. [PMID: 23768107 PMCID: PMC3701614 DOI: 10.1186/1756-6649-13-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 02/27/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Calculation of accumulated dose in fractionated radiotherapy based on spatial mapping of the dose points generally requires deformable image registration (DIR). The accuracy of the accumulated dose thus depends heavily on the DIR quality. This motivates investigations of how the registration uncertainty influences dose planning objectives and treatment outcome predictions.A framework was developed where the dose mapping can be associated with a variable known uncertainty to simulate the DIR uncertainties in a clinical workflow. The framework enabled us to study the dependence of dose planning metrics, and the predicted treatment outcome, on the DIR uncertainty. The additional planning margin needed to compensate for the dose mapping uncertainties can also be determined. We applied the simulation framework to a hypofractionated proton treatment of the prostate using two different scanning beam spot sizes to also study the dose mapping sensitivity to penumbra widths. RESULTS The planning parameter most sensitive to the DIR uncertainty was found to be the target D95. We found that the registration mean absolute error needs to be ≤0.20 cm to obtain an uncertainty better than 3% of the calculated D95 for intermediate sized penumbras. Use of larger margins in constructing PTV from CTV relaxed the registration uncertainty requirements to the cost of increased dose burdens to the surrounding organs at risk. CONCLUSIONS The DIR uncertainty requirements should be considered in an adaptive radiotherapy workflow since this uncertainty can have significant impact on the accumulated dose. The simulation framework enabled quantification of the accuracy requirement for DIR algorithms to provide satisfactory clinical accuracy in the accumulated dose.
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Affiliation(s)
- David Tilly
- Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Sweden
- Elekta Instruments AB, Uppsala, 753 21, Sweden
| | - Nina Tilly
- Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Sweden
- Elekta Instruments AB, Uppsala, 753 21, Sweden
| | - Anders Ahnesjö
- Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Sweden
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Allison RR, Sibata C, Patel R. Future radiation therapy: photons, protons and particles. Future Oncol 2013; 9:493-504. [DOI: 10.2217/fon.13.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Radiation therapy plays a critical role in the current management of cancer patients. The most common linear accelerator-based treatment device delivers photons of radiation. In an ever more precise fashion, state-of-the-art technology has recently allowed for both modulation of the radiation beam and imaging for this treatment delivery. This has resulted in better patient outcome with far fewer side effects than were achieved even a decade ago. Recently, a push has begun for proton therapy, which may have clinical advantage in select indications, although significant limitations for these devices have become apparent. In addition, currently, heavy particle therapy has been touted as a potential means to improve cancer patient outcomes. This article will highlight current benefits and drawbacks to modern radiation therapy and speculate on future tools that will likely dramatically improve radiation oncology.
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Affiliation(s)
- Ron R Allison
- 21st Century Oncology, 801 WH Smith Blvd., Greenville, NC 27834, USA.
| | | | - Rajen Patel
- 21st Century Oncology, 801 WH Smith Blvd., Greenville, NC 27834, USA
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Wognum S, Bondar L, Zolnay AG, Chai X, Hulshof MCCM, Hoogeman MS, Bel A. Control over structure-specific flexibility improves anatomical accuracy for point-based deformable registration in bladder cancer radiotherapy. Med Phys 2013; 40:021702. [DOI: 10.1118/1.4773040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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