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Jiao J, Zhou J, Li X, Xia M, Huang Y, Huang L, Wang N, Zhang X, Zhou S, Wang Y, Guo Y. USFM: A universal ultrasound foundation model generalized to tasks and organs towards label efficient image analysis. Med Image Anal 2024; 96:103202. [PMID: 38788326 DOI: 10.1016/j.media.2024.103202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/29/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024]
Abstract
Inadequate generality across different organs and tasks constrains the application of ultrasound (US) image analysis methods in smart healthcare. Building a universal US foundation model holds the potential to address these issues. Nevertheless, the development of such foundation models encounters intrinsic challenges in US analysis, i.e., insufficient databases, low quality, and ineffective features. In this paper, we present a universal US foundation model, named USFM, generalized to diverse tasks and organs towards label efficient US image analysis. First, a large-scale Multi-organ, Multi-center, and Multi-device US database was built, comprehensively containing over two million US images. Organ-balanced sampling was employed for unbiased learning. Then, USFM is self-supervised pre-trained on the sufficient US database. To extract the effective features from low-quality US images, we proposed a spatial-frequency dual masked image modeling method. A productive spatial noise addition-recovery approach was designed to learn meaningful US information robustly, while a novel frequency band-stop masking learning approach was also employed to extract complex, implicit grayscale distribution and textural variations. Extensive experiments were conducted on the various tasks of segmentation, classification, and image enhancement from diverse organs and diseases. Comparisons with representative US image analysis models illustrate the universality and effectiveness of USFM. The label efficiency experiments suggest the USFM obtains robust performance with only 20% annotation, laying the groundwork for the rapid development of US models in clinical practices.
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Affiliation(s)
- Jing Jiao
- Department of Electronic Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Jin Zhou
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaokang Li
- Department of Electronic Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Menghua Xia
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Yi Huang
- Department of Electronic Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Lihong Huang
- Department of Electronic Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Na Wang
- Department of Electronic Engineering, School of Information Science and Technology, Fudan University, Shanghai, China; SenseTime Research, Shanghai, China
| | - Xiaofan Zhang
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Shichong Zhou
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuanyuan Wang
- Department of Electronic Engineering, School of Information Science and Technology, Fudan University, Shanghai, China; Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention of Shanghai, Shanghai, China
| | - Yi Guo
- Department of Electronic Engineering, School of Information Science and Technology, Fudan University, Shanghai, China; Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention of Shanghai, Shanghai, China.
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Lu Q, Guo D, Wei Y, Zheng J, Li J. Role of gastrointestinal ultrasound in image-guided radiation therapy: A review. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2023. [DOI: 10.1016/j.jrras.2022.100520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Seitz PK, Karger CP, Bendl R, Schwahofer A. Strategy for automatic ultrasound (US) probe positioning in robot-assisted ultrasound guided radiation therapy. Phys Med Biol 2023; 68. [PMID: 36584398 DOI: 10.1088/1361-6560/acaf46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/30/2022] [Indexed: 12/31/2022]
Abstract
Objective. As part of image-guided radiotherapy, ultrasound-guided radiotherapy is currently already in use and under investigation for robot assisted systems Ipsen 2021. It promises a real-time tumor localization during irradiation (intrafractional) without extra dose. The ultrasound probe is held and guided by a robot. However, there is a lack of basic safety mechanisms and interaction strategies to enable a safe clinical procedure. In this study we investigate potential positioning strategies with safety mechanisms for a safe robot-human-interaction.Approach. A compact setup of ultrasound device, lightweight robot, tracking camera, force sensor and control computer were integrated in a software application to represent a potential USgRT setup. For the realization of a clinical procedure, positioning strategies for the ultrasound head with the help of the robot were developed, implemented, and tested. In addition, basic safety mechanisms for the robot have been implemented, using the integrated force sensor, and have been tested by intentional collisions.Main results. Various positioning methods from manual guidance to completely automated procedures were tested. Robot-guided methods achieved higher positioning accuracy and were faster in execution compared to conventional hand-guided methods. The developed safety mechanisms worked as intended and the detected collision force were below 20 N.Significance. The study demonstrates the feasibility of a new approach for safe robotic ultrasound imaging, with a focus on abdominal usage (liver, prostate, kidney). The safety measures applied here can be extended to other human-robot interactions and present the basic for further studies in medical applications.
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Affiliation(s)
- Peter Karl Seitz
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,University of Heidelberg, Faculty of Medicine Heidelberg, Heidelberg, Germany.,Medical Informatics, Heilbronn University, Heilbronn, Germany
| | - Christian P Karger
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Rolf Bendl
- Medical Informatics, Heilbronn University, Heilbronn, Germany
| | - Andrea Schwahofer
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,Therapanacea, Paris, France
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Li Y, Gong Z, Liu M, Li H, Gao H, Guo C, Yu L, Zhu C, Sun Z, Sun L, Xu H, He X. 3D-US and CBCT Dual-guided Radiotherapy for Postoperative Uterine Malignancy: A Primary Workflow Set-up. Technol Cancer Res Treat 2023; 22:15330338231212082. [PMID: 37993995 PMCID: PMC10666818 DOI: 10.1177/15330338231212082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 11/24/2023] Open
Abstract
Introduction: The consistency of clinical target volume is essential to guiding radiotherapy with precision for postoperative uterine malignancy patients. By introducing a three-dimensional ultrasound system (3D-US) into image-guided radiation therapy (IGRT), this study was designed to investigate the initial workflow set-up, the therapeutic potential, and the adverse events of 3D-US and cone-beam computed tomography (CBCT) dual-guided radiotherapy in postoperative uterine malignancy treatment. Methods: From April 2021 to December 2021, postoperative uterine malignancy patients were instructed to follow the previously standard protocol of daily radiation treatment, particularly a 3D-US (Clarity system) guiding was involved before CBCT. Soft-tissue-based displacements resulting from the additional US-IGRT were acquired in the LT (left)/RT (right), ANT (anterior)/POST (posterior), and SUP (superior)/INF(inferior) directions of the patient before fractional treatment. Displacement distributions before and after treatment either from 3D-US or from CBCT were also estimated and compared subsequently, and the urinary and rectal toxicity was further evaluated. Results: All the patients completed radiation treatment as planned. The assessment of 170 scans resulted in a mean displacement of (0.17 ± 0.24) cm, (0.19 ± 0.23) cm, (0.22 ± 0.26) cm for bladder in LT/RT, ANT/POST, and SUP/INF directions. A mean deviation of (0.26 ± 0.22) cm, (0.58 ± 0.5) cm, and (0.3 ± 0.23) cm was also observed for the bladder centroid between the CBCT and computed tomography -simulation images in three directions. Paired comparison between these two guidance shows that the variations from 3D-US are much smaller than those from CBCT in three directions, especially in ANT/POST and SUP/INF directions with significance (P = 0.000, 0.001, respectively). During treatment, and 0, 3, 6, 9, and 12 months after treatment, there was no severe urinary and rectal toxicity happened. Conclusion: A primary workflow of 3D-US and CBCT dual-guided radiotherapy has been established, which showed great therapeutic potential with mild to moderate urinary and rectal toxicity for postoperative uterine malignancy patients. But the clinical outcomes of this non-invasive technique need to be investigated further.
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Affiliation(s)
- Yang Li
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Zhen Gong
- Department of Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Mengyu Liu
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Huixin Li
- Department of Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Han Gao
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Chang Guo
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Le Yu
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Chenjing Zhu
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Zhihua Sun
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Li Sun
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Hanzi Xu
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Xia He
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
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Puvanasunthararajah S, Camps SM, Wille ML, Fontanarosa D. Combined clustered scan-based metal artifact reduction algorithm (CCS-MAR) for ultrasound-guided cardiac radioablation. Phys Eng Sci Med 2022; 45:1273-1287. [PMID: 36352318 DOI: 10.1007/s13246-022-01192-6] [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: 06/02/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022]
Abstract
Cardiac radioablation is a promising treatment for cardiac arrhythmias, but accurate dose delivery can be affected by heart motion. For this reason, real-time cardiac motion monitoring during radioablation is of paramount importance. Real-time ultrasound (US) guidance can be a solution. The US-guided cardiac radioablation workflow can be simplified by the simultaneous US and planning computed tomography (CT) acquisition, which can result in US transducer-induced metal artifacts on the planning CT scans. To reduce the impact of these artifacts, a new metal artifact reduction (MAR) algorithm (named: Combined Clustered Scan-based MAR [CCS-MAR]) has been developed and compared with iMAR (Siemens), O-MAR (Philips) and MDT (ReVision Radiology) algorithms. CCS-MAR is a fully automated sinogram inpainting-based MAR algorithm, which uses a two-stage correction process based on a normalized MAR method. The second stage aims to correct errors remaining from the first stage to create an artifact-free combined clustered scan for the process of metal artifact reduction. To evaluate the robustness of CCS-MAR, conventional CT scans and/or dual-energy CT scans from three anthropomorphic phantoms and transducers with different sizes were used. The performance of CCS-MAR for metal artifact reduction was compared with other algorithms through visual comparison, image quality metrics analysis, and HU value restoration evaluation. The results of this study show that CCS-MAR effectively reduced the US transducer-induced metal artifacts and that it improved HU value accuracy more or comparably to other MAR algorithms. These promising results justify future research into US transducer-induced metal artifact reduction for the US-guided cardiac radioablation purposes.
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Affiliation(s)
- Sathyathas Puvanasunthararajah
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia. .,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia.
| | | | - Marie-Luise Wille
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia.,School of Mechanical, Medical & Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia.,ARC ITTC for Multiscale 3D Imaging, Modelling, and Manufacturing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia
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Ji T, Feng Z, Sun E, Ng SK, Su L, Zhang Y, Han D, Han-Oh S, Iordachita I, Lee J, Kazanzides P, Bell MAL, Wong J, Ding K. A phantom-based analysis for tracking intra-fraction pancreatic tumor motion by ultrasound imaging during radiation therapy. Front Oncol 2022; 12:996537. [PMID: 36237341 PMCID: PMC9552199 DOI: 10.3389/fonc.2022.996537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeIn this study, we aim to further evaluate the accuracy of ultrasound tracking for intra-fraction pancreatic tumor motion during radiotherapy by a phantom-based study.MethodsTwelve patients with pancreatic cancer who were treated with stereotactic body radiation therapy were enrolled in this study. The displacement points of the respiratory cycle were acquired from 4DCT and transferred to a motion platform to mimic realistic breathing movements in our phantom study. An ultrasound abdominal phantom was placed and fixed in the motion platform. The ground truth of phantom movement was recorded by tracking an optical tracker attached to this phantom. One tumor inside the phantom was the tracking target. In the evaluation of the results, the monitoring results from the ultrasound system were compared with the phantom motion results from the infrared camera. Differences between infrared monitoring motion and ultrasound tracking motion were analyzed by calculating the root-mean-square error.ResultsThe 82.2% ultrasound tracking motion was within a 0.5 mm difference value between ultrasound tracking displacement and infrared monitoring motion. 0.7% ultrasound tracking failed to track accurately (a difference value > 2.5 mm). These differences between ultrasound tracking motion and infrared monitored motion do not correlate with respiratory displacements, respiratory velocity, or respiratory acceleration by linear regression analysis.ConclusionsThe highly accurate monitoring results of this phantom study prove that the ultrasound tracking system may be a potential method for real-time monitoring targets, allowing more accurate delivery of radiation doses.
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Affiliation(s)
- Tianlong Ji
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Ziwei Feng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Edward Sun
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sook Kien Ng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Lin Su
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Yin Zhang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Dong Han
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sarah Han-Oh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Iulian Iordachita
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Junghoon Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Peter Kazanzides
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, United States
| | - Muyinatu A. Lediju Bell
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - John Wong
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kai Ding
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- *Correspondence: Kai Ding,
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Li W, Ye X, Huang Y, Dong Y, Chen X, Yang Y. An integrated ultrasound imaging and abdominal compression device for respiratory motion management in radiation therapy. Med Phys 2022; 49:6334-6345. [PMID: 35950934 DOI: 10.1002/mp.15928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/13/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radiotherapy to tumors in the abdomen is challenging because of the significant organ movement and tissue deformation caused by respiration. PURPOSE A motion management strategy that integrated ultrasound (US) imaging with abdominal compression was developed and evaluated, where US was used to real-time monitor organ motion after abdominal compression. METHODS A device that combined a US imaging system and an abdominal compression plate (ACP) was developed. Twenty-one healthy volunteers were involved to evaluate the motion management efficacy. Each volunteer was immobilized on a flat bench by the device. Abdominal US data were successively collected with and without ACP compression and experiments were repeated three times to verify the imaging reproducibility. A template matching algorithm based on normalized cross correlation (NCC) was implemented to track the targets (vessels in the liver, pancreas and stomach) automatically. The matching algorithm was validated by comparing with the manual references. Automatic tracking was judged as failed if the center of mass difference from manual tracking was beyond a failure threshold. Based on the locations obtained through the template matching algorithm, the motion correlation between liver and pancreas/stomach was investigated using Pearson correlation test. Paired Student's t-test was used to analyze the difference between the results without and with ACP compression. RESULTS The liver motion amplitude over all 21 volunteers was significantly (p<0.001) reduced from 14.9 ± 5.5/3.4 ± 1.8 mm in superior-inferior (SI)/anterior-posterior (AP) direction before ACP compression to 7.3 ± 1.5/1.6 ± 0.7 mm after ACP compression. The mean liver motion standard deviation before compression was on average 2.8/1.4 mm in SI/AP direction, and was significantly (p<0.001) reduced to 0.9/0.4 mm after compression. The failure rates of automatic tracking for liver, pancreas and stomach were reduced for failure thresholds of 1-5 mm after applying ACP. The Pearson correlation coefficients between liver and pancreas/stomach were 0.98/0.97 without ACP and 0.96/0.94 with ACP in SI direction, and were 0.68/0.68 and 0.43/0.42 in AP direction. The motion prediction errors for pancreas/stomach with ACP have significantly (p<0.001) reduced to 0.45 ± 0.36/0.52 ± 0.43 mm from 0.69 ± 0.56/0.71 ± 0.66 mm without ACP in SI direction, and to 0.38 ± 0.33/0.39 ± 0.27 mm from 0.44 ± 0.35/0.61 ± 0.59 mm in AP direction. CONCLUSIONS The proposed strategy that combines real-time US imaging and abdominal compression has the potential to reduce the abdominal organ motion while improving both target tracking reliability and motion reproducibility. Furthermore, the observed correlation between liver and pancreas/stomach motion indicates the possibility of indirect pancreas/stomach tracking using liver markers as tracking surrogates. The strategy is expected to provide an alternative for respiratory motion management in the radiation treatment of abdominal tumors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Wanqing Li
- Department of Engineering and Applied Physics, University of Science and Technology of China, Hefei, Anhui, 230026, China
| | - Xianjun Ye
- Department of Ultrasound Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Yunwen Huang
- Department of Radiation Oncology, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Yuyan Dong
- Department of Engineering and Applied Physics, University of Science and Technology of China, Hefei, Anhui, 230026, China
| | - Xuemin Chen
- Health Management Center, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Yidong Yang
- Department of Engineering and Applied Physics, University of Science and Technology of China, Hefei, Anhui, 230026, China.,Department of Radiation Oncology, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, 230001, China
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Cheng X, Yang D, Zhong Y, Shao Y. Real-time marker-less tumor tracking with TOF PET: in silico feasibility study. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac6d9f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/06/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Purpose. Although positron emission tomography (PET) can provide a functional image of static tumors for RT guidance, it’s conventionally very challenging for PET to track a moving tumor in real-time with a multiple frame/s sampling rate. In this study, we developed a novel method to enable PET based three-dimension (3D) real-time marker-less tumor tracking (RMTT) and demonstrated its feasibility with a simulation study. Methods. For each line-of-response (LOR) acquired, its positron-electron annihilation position is calculated based on the time difference between the two gamma interactions detected by the TOF PET detectors. The accumulation of these annihilation positions from data acquired within a single sampling frame forms a coarsely measured 3D distribution of positron-emitter radiotracer uptakes of the lung tumor and other organs and tissues (background). With clinically relevant tumor size and sufficient differential radiotracer uptake concentrations between the tumor and background, the high-uptake tumor can be differentiated from the surrounding low-uptake background in the measured distribution of radiotracer uptakes. With a volume-of-interest (VOI) that closely encloses the tumor, the count-weighted centroid of the annihilation positions within the VOI can be calculated as the tumor position. All these data processes can be conducted online. The feasibility of the new method was investigated with a simulated cardiac-torso digital phantom and stationary dual-panel TOF PET detectors to track a 28 mm diameter lung tumor with a 4:1 tumor-to-background 18FDG activity concentration ratio. Results. The initial study shows TOF PET based RMTT can achieve <2.0 mm tumor tracking accuracy with 5 frame s−1 sampling rate under the simulated conditions. In comparison, using reconstructed PET images to track a similar size tumor would require >30 s acquisition time to achieve the same tracking accuracy. Conclusion. With the demonstrated feasibility, the new method may enable TOF PET based RMTT for practical RT applications.
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Perrin R, Maguire P, Garonna A, Weidlich G, Bulling S, Fargier-Voiron M, De Marco C, Rossi E, Ciocca M, Vitolo V, Mirandola A. Case Report: Treatment Planning Study to Demonstrate Feasibility of Transthoracic Ultrasound Guidance to Facilitate Ventricular Tachycardia Ablation With Protons. Front Cardiovasc Med 2022; 9:849247. [PMID: 35600462 PMCID: PMC9116532 DOI: 10.3389/fcvm.2022.849247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/28/2022] [Indexed: 12/17/2022] Open
Abstract
BackgroundCardiac arrhythmias, such as ventricular tachycardia, are disruptions in the normal cardiac function that originate from problems in the electrical conduction of signals inside the heart. Recently, a non-invasive treatment option based on external photon or proton beam irradiation has been used to ablate the arrhythmogenic structures. Especially in proton therapy, based on its steep dose gradient, it is crucial to monitor the motion of the heart in order to ensure that the radiation dose is delivered to the correct location. Transthoracic ultrasound imaging has the potential to provide guidance during this treatment delivery. However, it has to be noted that the presence of an ultrasound probe on the chest of the patient introduces constraints on usable beam angles for both protons and photon treatments. This case report investigates the possibility to generate a clinically acceptable proton treatment plan while the ultrasound probe is present on the chest of the patient.CaseA treatment plan study was performed based on a 4D cardiac-gated computed tomography scan of a 55 year-old male patient suffering from refractory ventricular tachycardia who underwent cardiac radioablation. A proton therapy treatment plan was generated for the actual treatment target in presence of an ultrasound probe on the chest of this patient. The clinical acceptability of the generated plan was confirmed by evaluating standard target dose-volume metrics, dose to organs-at-risk and target dose conformity and homogeneity.ConclusionThe generation of a clinically acceptable proton therapy treatment plan for cardiac radioablation of ventricular tachycardia could be performed in the presence of an ultrasound probe on the chest of the patient. These results establish a basis and justification for continued research and product development for ultrasound-guided cardiac radioablation.
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Affiliation(s)
| | | | - Adriano Garonna
- EBAMed SA, Geneva, Switzerland
- *Correspondence: Adriano Garonna
| | - Georg Weidlich
- Radiation Oncology, National Medical Physics and Dosimetry Company, Palo Alto, CA, United States
| | | | | | | | - Eleonora Rossi
- Centro Nazionale di Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Viviana Vitolo
- Centro Nazionale di Adroterapia Oncologica (CNAO), Pavia, Italy
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Sharma M, Nano TF, Akkati M, Milano MT, Morin O, Feng M. A systematic review and meta-analysis of liver tumor position variability during SBRT using various motion management and IGRT strategies. Radiother Oncol 2021; 166:195-202. [PMID: 34843841 DOI: 10.1016/j.radonc.2021.11.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To suggest PTV margins for liver SBRT with different motion management strategies based on a systematic review and meta-analysis. METHODS In accordance with Preferred-Reporting-Items-for-Systematic-Reviews-and-Meta-Analyses (PRISMA), a systematic review in PubMed, Embase and Medline databases was performed for liver tumor position variability. From an initial 533 studies published before October 2020, 36 studies were categorized as 18 free-breathing (FB; npatients = 401), 9 abdominal compression (AC; npatients = 145) and 9 breath-hold (BH; npatients = 126). A meta-analysis was performed on inter- and intra-fraction position variability to report weighted-mean with 95% confidence interval (CI95) in superior-inferior (SI), left-right (LR) and anterior-posterior (AP) directions. Furthermore, weighted-mean ITV margins were computed for FB (nstudies = 15, npatients = 373) and AC (nstudies = 6, npatients = 97) and PTV margins were computed for FB (nstudies = 6, npatients = 95), AC (nstudies = 7, npatients = 106) and BH (nstudies = 8, npatients = 133). RESULTS The FB weighted-mean intra-fraction variability, ITV margins and weighted-standard-deviation in mm were SI-9.7, CI95 = 9.3-10.1, 13.5 ± 4.9; LR-5.4, CI95 = 5.3-5.6, 7.3 ± 7.9; and AP-4.2, CI95 = 4.0-4.4, 6.3 ± 7.6. The inter-fraction-based results were SI-4.7, CI95 = 4.3-5.1, 5.7 ± 1.7; LR-1.4, CI95 = 1.1-1.6, 3.6 ± 2.7; and AP-2.8, CI95 = 2.5-3.1, 4.8 ± 2.1. For AC intra-fraction results in mm were SI-1.8, CI95 = 1.6-2.0, 2.6 ± 1.2; LR-0.7, CI95 = 0.6-0.8, 1.7 ± 1.5; and AP-0.9, CI95 = 0.8-1.0, 1.9 ± 1.7. The inter-fraction results were SI-2.6, CI95 = 2.3-3.0, 5.2 ± 2.9; LR-1.9, CI95 = 1.7-2.1, 4.0 ± 2.2; and AP-2.9, CI95 = 2.5-3.2, 5.8 ± 2.7. For BH the inter-fraction variability, and the weighted-mean PTV margins and weighted-standard-deviation in mm were SI-2.4, CI95 = 2.1-2.7, 5.6 ± 2.9; LR-1.8, CI95 = 1.3-2.2, 5.5 ± 1.7; and AP-1.4; CI95 = 1.2-1.7, 6.1 ± 2.1. CONCLUSION Our meta-analysis suggests a symmetric weighted-mean PTV margin of 6 mm might be appropriate for BH. For AC and FB, asymmetric PTV margins (weighted-mean margin of 4 mm (AP), 6 mm (SI/LR)) might be appropriate. For FB, if larger (>ITV margin) intra-fraction variability observed, the additional intra- and inter-fraction variability should be accounted in the PTV margin.
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Affiliation(s)
- Manju Sharma
- University of California, San Francisco, United States.
| | - Tomi F Nano
- University of California, San Francisco, United States
| | | | | | - Olivier Morin
- University of California, San Francisco, United States
| | - Mary Feng
- University of California, San Francisco, United States
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11
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Mezheritsky T, Romaguera LV, Le W, Kadoury S. Population-based 3D respiratory motion modelling from convolutional autoencoders for 2D ultrasound-guided radiotherapy. Med Image Anal 2021; 75:102260. [PMID: 34670149 DOI: 10.1016/j.media.2021.102260] [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: 03/19/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
Radiotherapy is a widely used treatment modality for various types of cancers. A challenge for precise delivery of radiation to the treatment site is the management of internal motion caused by the patient's breathing, especially around abdominal organs such as the liver. Current image-guided radiation therapy (IGRT) solutions rely on ionising imaging modalities such as X-ray or CBCT, which do not allow real-time target tracking. Ultrasound imaging (US) on the other hand is relatively inexpensive, portable and non-ionising. Although 2D US can be acquired at a sufficient temporal frequency, it doesn't allow for target tracking in multiple planes, while 3D US acquisitions are not adapted for real-time. In this work, a novel deep learning-based motion modelling framework is presented for ultrasound IGRT. Our solution includes an image similarity-based rigid alignment module combined with a deep deformable motion model. Leveraging the representational capabilities of convolutional autoencoders, our deformable motion model associates complex 3D deformations with 2D surrogate US images through a common learned low dimensional representation. The model is trained on a variety of deformations and anatomies which enables it to generate the 3D motion experienced by the liver of a previously unseen subject. During inference, our framework only requires two pre-treatment 3D volumes of the liver at extreme breathing phases and a live 2D surrogate image representing the current state of the organ. In this study, the presented model is evaluated on a 3D+t US data set of 20 volunteers based on image similarity as well as anatomical target tracking performance. We report results that surpass comparable methodologies in both metric categories with a mean tracking error of 3.5±2.4 mm, demonstrating the potential of this technique for IGRT.
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Affiliation(s)
- Tal Mezheritsky
- MedICAL Laboratory, École Polytechnique de Montréal, Montréal, Canada.
| | | | | | - Samuel Kadoury
- MedICAL Laboratory, École Polytechnique de Montréal, Montréal, Canada; CHUM Research Center, Montréal, Canada
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12
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Bednarz BP, Jupitz S, Lee W, Mills D, Chan H, Fiorillo T, Sabitini J, Shoudy D, Patel A, Mitra J, Sarcar S, Wang B, Shepard A, Matrosic C, Holmes J, Culberson W, Bassetti M, Hill P, McMillan A, Zagzebski J, Smith LS, Foo TK. First-in-human imaging using a MR-compatible e4D ultrasound probe for motion management of radiotherapy. Phys Med 2021; 88:104-110. [PMID: 34218199 DOI: 10.1016/j.ejmp.2021.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 06/08/2021] [Accepted: 06/21/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Respiration-induced tumor or organ positional changes can impact the accuracy of external beam radiotherapy. Motion management strategies are used to account for these changes during treatment. The authors report on the development, testing, and first-in-human evaluation of an electronic 4D (e4D) MR-compatible ultrasound probe that was designed for hands-free operation in a MR and linear accelerator (LINAC) environment. METHODS Ultrasound components were evaluated for MR compatibility. Electromagnetic interference (EMI) shielding was used to enclose the entire probe and a factory-fabricated cable shielded with copper braids was integrated into the probe. A series of simultaneous ultrasound and MR scans were acquired and analyzed in five healthy volunteers. RESULTS The ultrasound probe led to minor susceptibility artifacts in the MR images immediately proximal to the ultrasound probe at a depth of <10 mm. Ultrasound and MR-based motion traces that were derived by tracking the salient motion of endogenous target structures in the superior-inferior (SI) direction demonstrated good concordance (Pearson correlation coefficients of 0.95-0.98) between the ultrasound and MRI datasets. CONCLUSION We have demonstrated that our hands-free, e4D probe can acquire ultrasound images during a MR acquisition at frame rates of approximately 4 frames per second (fps) without impacting either the MR or ultrasound image quality. This use of this technology for interventional procedures (e.g. biopsies and drug delivery) and motion compensation during imaging are also being explored.
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Affiliation(s)
- Bryan P Bednarz
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States.
| | - Sydney Jupitz
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Warren Lee
- GE Global Research, Niskayuna, NY 12309, United States
| | - David Mills
- GE Global Research, Niskayuna, NY 12309, United States
| | - Heather Chan
- GE Global Research, Niskayuna, NY 12309, United States
| | | | | | - David Shoudy
- GE Global Research, Niskayuna, NY 12309, United States
| | - Aqsa Patel
- GE Global Research, Niskayuna, NY 12309, United States
| | - Jhimli Mitra
- GE Global Research, Niskayuna, NY 12309, United States
| | | | - Bo Wang
- GE Global Research, Niskayuna, NY 12309, United States
| | - Andrew Shepard
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States; Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, United States
| | - Charles Matrosic
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, United States
| | - James Holmes
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Wesley Culberson
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Michael Bassetti
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Patrick Hill
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Alan McMillan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - James Zagzebski
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - L Scott Smith
- GE Global Research, Niskayuna, NY 12309, United States
| | - Thomas K Foo
- GE Global Research, Niskayuna, NY 12309, United States
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13
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DI Franco R, Borzillo V, Alberti D, Ametrano G, Petito A, Coppolaro A, Tarantino I, Rossetti S, Pignata S, Iovane G, Perdonà S, Quarto G, Grimaldi G, Izzo A, Castaldo L, Muscariello R, Serra M, Facchini G, Muto P. Acute Toxicity in Hypofractionated/Stereotactic Prostate Radiotherapy of Elderly Patients: Use of the Image-guided Radio Therapy (IGRT) Clarity System. In Vivo 2021; 35:1849-1856. [PMID: 33910872 DOI: 10.21873/invivo.12447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The use of intra-fractional monitoring and correction of prostate position with the Image Guided Radio Therapy (IGRT) system can increase the spatial accuracy of dose delivery. Clarity is a system used for intrafraction prostate-motion management, it provides a real-time visualization of prostate with a transperineal ultrasound. The aim of this study was to evaluate the use of Clarity-IGRT on proper intrafraction alignment and monitoring, its impact on Planning Tumor Volume margin and on urinary and rectal toxicity in elderly patients not eligible for surgery. PATIENTS AND METHODS Twenty-five elderly prostate cancer patients, median age=75 years (range=75-90 years) were treated with Volumetric Radiotherapy and Clarity-IGRT using 3 different schemes: A) 64.5/72 Gray (Gy) in 30 fractions on prostate and seminal vesicles (6 patients); B) 35 Gy in 5 fractions on prostate and seminal vesicles (12 patients); C): 35 Gy in 5 fractions on prostate (7 patients). Ultrasound identification of the overlapped structures to the detected ones during simulation has been used in each session. A specific software calculates direction and entity of necessary shift to obtain the perfect match. The average misalignment in the three-dimensional space has been determined and shown in a box-plot. RESULTS All patients completed treatment with mild-moderate toxicity. During treatment, genitourinary toxicity was 32% Grade 1; 4% Grade 2, rectal was 4% Grade 1. At follow-up of 3 months, genitourinary toxicity was 20% Grade 1; 4% Grade 2, rectal toxicity was 4% Grade 2. At follow-up of 6 months, genitourinary toxicity was 4% Grade 1; 4% Grade 2. Rectal toxicity was 4% Grade 2. CONCLUSION Radiotherapy with the Clarity System allows a reduction of PTV margins, the amount of fractions can be reduced increasing the total dose, not exacerbating urinary and rectal toxicity with greater patient's compliance.
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Affiliation(s)
- Rossella DI Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy;
| | - Valentina Borzillo
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Domingo Alberti
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Gianluca Ametrano
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Angela Petito
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Andrea Coppolaro
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Ilaria Tarantino
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sabrina Rossetti
- Departmental Unit Of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sandro Pignata
- Departmental Unit Of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Gelsomina Iovane
- Departmental Unit Of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sisto Perdonà
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Giuseppe Quarto
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Giovanni Grimaldi
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Alessandro Izzo
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Luigi Castaldo
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Raffaele Muscariello
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Marcello Serra
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Gaetano Facchini
- Department of Hospital Medicine, Unit of Medical Oncology, ASL Napoli 2 Nord, "S.M. delle Grazie" Hospital, Pozzuoli, Italy
| | - Paolo Muto
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
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14
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Ipsen S, Wulff D, Kuhlemann I, Schweikard A, Ernst F. Towards automated ultrasound imaging-robotic image acquisition in liver and prostate for long-term motion monitoring. Phys Med Biol 2021; 66. [PMID: 33770768 DOI: 10.1088/1361-6560/abf277] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/26/2021] [Indexed: 11/12/2022]
Abstract
Real-time volumetric (4D) ultrasound has shown high potential for diagnostic and therapy guidance tasks. One of the main drawbacks of ultrasound imaging to date is the reliance on manual probe positioning and the resulting user dependence. Robotic assistance could help overcome this issue and facilitate the acquisition of long-term image data to observe dynamic processesin vivoover time. The aim of this study is to assess the feasibility of robotic probe manipulation and organ motion quantification during extended imaging sessions. The system consists of a collaborative robot and a 4D ultrasound system providing real-time data access. Five healthy volunteers received liver and prostate scans during free breathing over 30 min. Initial probe placement was performed with real-time remote control with a predefined contact force of 10 N. During scan acquisition, the probe position was continuously adjusted to the body surface motion using impedance control. Ultrasound volumes, the pose of the end-effector and the estimated contact forces were recorded. For motion analysis, one anatomical landmark was manually annotated in a subset of ultrasound frames for each experiment. Probe contact was uninterrupted over the entire scan duration in all ten sessions. Organ drift and imaging artefacts were successfully compensated using remote control. The median contact force along the probe's longitudinal axis was 10.0 N with maximum values of 13.2 and 21.3 N for liver and prostate, respectively. Forces exceeding 11 N only occurred in 0.3% of the time. Probe and landmark motion were more pronounced in the liver, with median interquartile ranges of 1.5 and 9.6 mm, compared to 0.6 and 2.7 mm in the prostate. The results show that robotic ultrasound imaging with dynamic force control can be used for stable, long-term imaging of anatomical regions affected by motion. The system facilitates the acquisition of 4D image datain vivoover extended scanning periods for the first time and holds the potential to be used for motion monitoring for therapy guidance as well as diagnostic tasks.
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Affiliation(s)
- Svenja Ipsen
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany.,Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering IMTE, Luebeck, Germany
| | - Daniel Wulff
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - Ivo Kuhlemann
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - Achim Schweikard
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - Floris Ernst
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
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15
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Kieselmann JP, Fuller CD, Gurney-Champion OJ, Oelfke U. Cross-modality deep learning: Contouring of MRI data from annotated CT data only. Med Phys 2021; 48:1673-1684. [PMID: 33251619 PMCID: PMC8058228 DOI: 10.1002/mp.14619] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 08/03/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Online adaptive radiotherapy would greatly benefit from the development of reliable auto-segmentation algorithms for organs-at-risk and radiation targets. Current practice of manual segmentation is subjective and time-consuming. While deep learning-based algorithms offer ample opportunities to solve this problem, they typically require large datasets. However, medical imaging data are generally sparse, in particular annotated MR images for radiotherapy. In this study, we developed a method to exploit the wealth of publicly available, annotated CT images to generate synthetic MR images, which could then be used to train a convolutional neural network (CNN) to segment the parotid glands on MR images of head and neck cancer patients. METHODS Imaging data comprised 202 annotated CT and 27 annotated MR images. The unpaired CT and MR images were fed into a 2D CycleGAN network to generate synthetic MR images from the CT images. Annotations of axial slices of the synthetic images were generated by propagating the CT contours. These were then used to train a 2D CNN. We assessed the segmentation accuracy using the real MR images as test dataset. The accuracy was quantified with the 3D Dice similarity coefficient (DSC), Hausdorff distance (HD), and mean surface distance (MSD) between manual and auto-generated contours. We benchmarked the approach by a comparison to the interobserver variation determined for the real MR images, as well as to the accuracy when training the 2D CNN to segment the CT images. RESULTS The determined accuracy (DSC: 0.77±0.07, HD: 18.04±12.59mm, MSD: 2.51±1.47mm) was close to the interobserver variation (DSC: 0.84±0.06, HD: 10.85±5.74mm, MSD: 1.50±0.77mm), as well as to the accuracy when training the 2D CNN to segment the CT images (DSC: 0.81±0.07, HD: 13.00±7.61mm, MSD: 1.87±0.84mm). CONCLUSIONS The introduced cross-modality learning technique can be of great value for segmentation problems with sparse training data. We anticipate using this method with any nonannotated MRI dataset to generate annotated synthetic MR images of the same type via image style transfer from annotated CT images. Furthermore, as this technique allows for fast adaptation of annotated datasets from one imaging modality to another, it could prove useful for translating between large varieties of MRI contrasts due to differences in imaging protocols within and between institutions.
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Affiliation(s)
- Jennifer P. Kieselmann
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
| | - Oliver J. Gurney-Champion
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
| | - Uwe Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
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16
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Huang Y, Yang K, Lai Y, Liu H, Shen C, Zhong Y, Shao Y, Li X, Liu B, Jia X. Experimental and numerical studies on kV scattered x-ray imaging for real-time image guidance in radiation therapy. Phys Med Biol 2021; 66:045022. [PMID: 33361559 DOI: 10.1088/1361-6560/abd66c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Motion management is a critical component of image guided radiotherapy for lung cancer. We previously proposed a scheme using kV scattered x-ray photons for marker-less real-time image guidance in lung cancer radiotherapy. This study reports our recent progress using the photon counting detection technique to demonstrate potential feasibility of this method and using Monte Carlo (MC) simulations and ray-tracing calculations to characterize the performance. In our scheme, a thin slice of x-ray beam was directed to the target and we measured the outgoing scattered photons using a photon counting detector with a parallel-hole collimator to establish the correspondence between detector pixels and scatter positions. Image corrections of geometry, beam attenuation and scattering angle were performed to convert the raw image to the actual image of Compton attenuation coefficient. We set up a MC simulation system using an in-house developed GPU-based MC package modeling the image formation process. We also performed ray-tracing calculations to investigate the impacts of imaging system geometry on resulting image resolution. The experiment demonstrated feasibility of using a photon counting detector to measure scattered x-ray photons and generate the proposed scattered x-ray image. After correction, x-ray scattering image intensity and Compton scattering attenuation coefficient were linearly related, with R 2 greater than 0.9. Contrast to noise ratios of different objects were improved and the values in experimental results and MC simulation results agreed with each other. Ray-tracing calculations revealed the dependence of image resolution on imaging geometry. The image resolution increases with reduced source to object distance and increased collimator height. The study demonstrated potential feasibility of using scattered x-ray imaging as a real-time image guidance method in radiation therapy.
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Affiliation(s)
- Yanqi Huang
- Innovative Technology Of Radiotherapy Computations and Hardware (iTORCH) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75235, United States of America. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75235, United States of America
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Chetvertkov M, Monroe JI, Boparai J, Solberg TD, Pafundi DH, Ruo RL, Gladstone DJ, Yin FF, Chetty IJ, Benedict S, Followill DS, Xiao Y, Sohn JW. NRG Oncology Survey on Practice and Technology Use in SRT and SBRT Delivery. Front Oncol 2020; 10:602607. [PMID: 33330102 PMCID: PMC7729187 DOI: 10.3389/fonc.2020.602607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/27/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To assess stereotactic radiotherapy (SRT)/stereotactic body radiotherapy (SBRT) practices by polling clinics participating in multi-institutional clinical trials. METHODS The NRG Oncology Medical Physics Subcommittee distributed a survey consisting of 23 questions, which covered general technologies, policies, and procedures used in the Radiation Oncology field for the delivery of SRT/SBRT (9 questions), and site-specific questions for brain SRT, lung SBRT, and prostate SBRT (14 questions). Surveys were distributed to 1,996 radiotherapy institutions included on the membership rosters of the five National Clinical Trials Network (NCTN) groups. Patient setup, motion management, target localization, prescriptions, and treatment delivery technique data were reported back by 568 institutions (28%). RESULTS 97.5% of respondents treat lung SBRT patients, 77.0% perform brain SRT, and 29.1% deliver prostate SBRT. 48.8% of clinics require a physicist present for every fraction of SBRT, 18.5% require a physicist present for the initial SBRT fraction only, and 14.9% require a physicist present for the entire first fraction, including set-up approval for all subsequent fractions. 55.3% require physician approval for all fractions, and 86.7% do not reposition without x-ray imaging. For brain SRT, most institutions (83.9%) use a planning target volume (PTV) margin of 2 mm or less. Lung SBRT PTV margins of 3 mm or more are used in 80.6% of clinics. Volumetric modulated arc therapy (VMAT) is the dominant delivery method in 62.8% of SRT treatments, 70.9% of lung SBRT, and 68.3% of prostate SBRT. CONCLUSION This report characterizes SRT/SBRT practices in radiotherapy clinics participating in clinical trials. Data made available here allows the radiotherapy community to compare their practice with that of other clinics, determine what is achievable, and assess areas for improvement.
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Affiliation(s)
| | - James Ira Monroe
- Department of Radiation Oncology, Mercy Hospital South, St. Louis, MO, United States
| | - Jaskaran Boparai
- Operations Department, NRG Oncology, Philadelphia, PA, United States
| | - Timothy D. Solberg
- United States Food and Drug Administration, Silver Spring, MD, United States
| | - Deanna H. Pafundi
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Russell L. Ruo
- Department of Medical Physics, McGill University Health Centre, Montreal, QC, Canada
| | - David J. Gladstone
- Radiation Oncology Department, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Fang-Fang Yin
- Radiation Oncology Department, Duke University Medical Center, Durham, NC, United States
| | - Indrin J. Chetty
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI, United States
| | - Stanley Benedict
- Department of Radiation Oncology, University of California at Davis, Sacramento, CA, United States
| | - David S. Followill
- IROC Houston Quality Assurance Center, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Jason W. Sohn
- Cancer Institute, Allegheny Health Network, Pittsburgh, PA, United States
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18
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Szegedi M, Boehm C, Paxton A, Rassiah‐Szegedi P, Sarkar V, Zhao H, Su F, Kokeny KE, Lloyd S, Tward J, Salter BJ. Comparison of transperineal ultrasound image guidance technique to transabdominal technique for prostate radiation therapy. Med Phys 2020; 47:6113-6121. [DOI: 10.1002/mp.14522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/01/2020] [Accepted: 09/21/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Martin Szegedi
- Department of Radiation Oncology University of Utah Salt Lake City UT84112USA
| | - Christine Boehm
- Universitätsklinikum Düsseldorf Klinik für Strahlentherapie und Radioonkologie Düsseldorf Germany
| | - Adam Paxton
- Department of Radiation Oncology University of Utah Salt Lake City UT84112USA
| | | | - Vikren Sarkar
- Department of Radiation Oncology University of Utah Salt Lake City UT84112USA
| | - Hui Zhao
- Department of Radiation Oncology University of Utah Salt Lake City UT84112USA
| | - Frances Su
- Department of Radiation Oncology University of Utah Salt Lake City UT84112USA
| | - Kristine E. Kokeny
- Department of Radiation Oncology University of Utah Salt Lake City UT84112USA
| | - Shane Lloyd
- Department of Radiation Oncology University of Utah Salt Lake City UT84112USA
| | - Jonathan Tward
- Department of Radiation Oncology University of Utah Salt Lake City UT84112USA
| | - Bill J. Salter
- Department of Radiation Oncology University of Utah Salt Lake City UT84112USA
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Grimwood A, Rivaz H, Zhou H, McNair HA, Jakubowski K, Bamber JC, Tree AC, Harris EJ. Improving 3D ultrasound prostate localisation in radiotherapy through increased automation of interfraction matching. Radiother Oncol 2020; 149:134-141. [PMID: 32387546 PMCID: PMC7456791 DOI: 10.1016/j.radonc.2020.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 12/04/2022]
Abstract
BACKGROUND AND PURPOSE Daily image guidance is standard care for prostate radiotherapy. Innovations which improve the accuracy and efficiency of ultrasound guidance are needed, particularly with respect to reducing interobserver variation. This study explores automation tools for this purpose, demonstrated on the Elekta Clarity Autoscan®. The study was conducted as part of the Clarity-Pro trial (NCT02388308). MATERIALS AND METHODS Ultrasound scan volumes were collected from 32 patients. Prostate matches were performed using two proposed workflows and the results compared with Clarity's proprietary software. Gold standard matches derived from manually localised landmarks provided a reference. The two workflows incorporated a custom 3D image registration algorithm, which was benchmarked against a third-party application (Elastix). RESULTS Significant reductions in match errors were reported from both workflows compared to standard protocol. Median (IQR) absolute errors in the left-right, anteroposterior and craniocaudal axes were lowest for the Manually Initiated workflow: 0.7(1.0) mm, 0.7(0.9) mm, 0.6(0.9) mm compared to 1.0(1.7) mm, 0.9(1.4) mm, 0.9(1.2) mm for Clarity. Median interobserver variation was ≪0.01 mm in all axes for both workflows compared to 2.2 mm, 1.7 mm, 1.5 mm for Clarity in left-right, anteroposterior and craniocaudal axes. Mean matching times was also reduced to 43 s from 152 s for Clarity. Inexperienced users of the proposed workflows attained better match precision than experienced users on Clarity. CONCLUSION Automated image registration with effective input and verification steps should increase the efficacy of interfraction ultrasound guidance compared to the current commercially available tools.
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Affiliation(s)
- Alexander Grimwood
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK
| | - Hassan Rivaz
- Department of Electrical and Computer Engineering, Concordia University, Montreal, Canada
| | - Hang Zhou
- Department of Electrical and Computer Engineering, Concordia University, Montreal, Canada
| | - Helen A McNair
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK
| | | | - Jeffrey C Bamber
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK
| | - Alison C Tree
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK
| | - Emma J Harris
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK.
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Schmitt D, Blanck O, Gauer T, Fix MK, Brunner TB, Fleckenstein J, Loutfi-Krauss B, Manser P, Werner R, Wilhelm ML, Baus WW, Moustakis C. Technological quality requirements for stereotactic radiotherapy : Expert review group consensus from the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. Strahlenther Onkol 2020; 196:421-443. [PMID: 32211939 PMCID: PMC7182540 DOI: 10.1007/s00066-020-01583-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 12/25/2022]
Abstract
This review details and discusses the technological quality requirements to ensure the desired quality for stereotactic radiotherapy using photon external beam radiotherapy as defined by the DEGRO Working Group Radiosurgery and Stereotactic Radiotherapy and the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The covered aspects of this review are 1) imaging for target volume definition, 2) patient positioning and target volume localization, 3) motion management, 4) collimation of the irradiation and beam directions, 5) dose calculation, 6) treatment unit accuracy, and 7) dedicated quality assurance measures. For each part, an expert review for current state-of-the-art techniques and their particular technological quality requirement to reach the necessary accuracy for stereotactic radiotherapy divided into intracranial stereotactic radiosurgery in one single fraction (SRS), intracranial fractionated stereotactic radiotherapy (FSRT), and extracranial stereotactic body radiotherapy (SBRT) is presented. All recommendations and suggestions for all mentioned aspects of stereotactic radiotherapy are formulated and related uncertainties and potential sources of error discussed. Additionally, further research and development needs in terms of insufficient data and unsolved problems for stereotactic radiotherapy are identified, which will serve as a basis for the future assignments of the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The review was group peer-reviewed, and consensus was obtained through multiple working group meetings.
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Affiliation(s)
- Daniela Schmitt
- Klinik für Radioonkologie und Strahlentherapie, National Center for Radiation Research in Oncology (NCRO), Heidelberger Institut für Radioonkologie (HIRO), Universitätsklinikum Heidelberg, Heidelberg, Germany.
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Tobias Gauer
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Michael K Fix
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Thomas B Brunner
- Universitätsklinik für Strahlentherapie, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Jens Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Britta Loutfi-Krauss
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Peter Manser
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Rene Werner
- Institut für Computational Neuroscience, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maria-Lisa Wilhelm
- Klinik für Strahlentherapie, Universitätsmedizin Rostock, Rostock, Germany
| | - Wolfgang W Baus
- Klinik für Radioonkologie, CyberKnife- und Strahlentherapie, Universitätsklinikum Köln, Cologne, Germany
| | - Christos Moustakis
- Klinik für Strahlentherapie-Radioonkologie, Universitätsklinikum Münster, Münster, Germany
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Richter A, Exner F, Weick S, Lawrenz I, Polat B, Flentje M, Mantel F. Evaluation of intrafraction prostate motion tracking using the Clarity Autoscan system for safety margin validation. Z Med Phys 2020; 30:135-141. [DOI: 10.1016/j.zemedi.2019.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/18/2019] [Accepted: 12/11/2019] [Indexed: 02/08/2023]
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22
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Mason SA, White IM, Lalondrelle S, Bamber JC, Harris EJ. The Stacked-Ellipse Algorithm: An Ultrasound-Based 3-D Uterine Segmentation Tool for Enabling Adaptive Radiotherapy for Uterine Cervix Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1040-1052. [PMID: 31926750 PMCID: PMC7043010 DOI: 10.1016/j.ultrasmedbio.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 06/10/2023]
Abstract
The stacked-ellipse (SE) algorithm was developed to rapidly segment the uterus on 3-D ultrasound (US) for the purpose of enabling US-guided adaptive radiotherapy (RT) for uterine cervix cancer patients. The algorithm was initialised manually on a single sagittal slice to provide a series of elliptical initialisation contours in semi-axial planes along the uterus. The elliptical initialisation contours were deformed according to US features such that they conformed to the uterine boundary. The uterus of 15 patients was scanned with 3-D US using the Clarity System (Elekta Ltd.) at multiple days during RT and manually contoured (n = 49 images and corresponding contours). The median (interquartile range) Dice similarity coefficient and mean surface-to-surface-distance between the SE algorithm and manual contours were 0.80 (0.03) and 3.3 (0.2) mm, respectively, which are within the ranges of reported inter-observer contouring variabilities. The SE algorithm could be implemented in adaptive RT to precisely segment the uterus on 3-D US.
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Affiliation(s)
- Sarah A Mason
- Joint Department of Physics, Institute of Cancer Research, London, United Kingdom
| | - Ingrid M White
- Radiotherapy Department, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Susan Lalondrelle
- Radiotherapy Department, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jeffrey C Bamber
- Joint Department of Physics, Institute of Cancer Research, London, United Kingdom
| | - Emma J Harris
- Joint Department of Physics, Institute of Cancer Research, London, United Kingdom.
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Iommi D, Hummel J, Figl ML. Evaluation of 3D ultrasound for image guidance. PLoS One 2020; 15:e0229441. [PMID: 32214326 PMCID: PMC7098612 DOI: 10.1371/journal.pone.0229441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/06/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE In this paper we compared two different 3D ultrasound (US) modes (3D free-hand mode and 3D wobbler mode) to see which is more suitable to perform the 3D-US/3D-US registration for clinical guidance applications. The typical errors with respect to their impact on the final localization error were evaluated step by step. METHODS Multi-point target and Hand-eye calibration methods were used for 3D US calibration together with a newly designed multi-cone phantom. Pointer based and image based methods were used for 2D US calibration. The calibration target error was computed by using a different multi-cone phantom. An egg-shaped phantom was used as ground truth to compare distortions for both 3D modes along with the measurements of the volume. Finally, we compared 3D ultrasound images acquired by 3D wobbler mode and 3D free-hand mode with respect to their 3D-US/3D-US registration accuracy using both, phantom and patient data. A theoretical step by step error analysis was performed and compared to empirical data. RESULTS Target registration errors based on the calibration with the 3D Multi-point and 2D pointer/image method have been found to be comparable (∼1mm). They both outperformed the 3D Hand-eye method (error >2mm). Volume measurements with the 3D free-hand mode were closest to the ground truth (around 6% error compared to 9% with the 3D wobbler mode). Additional scans on phantoms showed a 3D-US/3D-US registration error below 1 mm for both, the 3D free-hand mode and the 3D wobbler mode, respectively. Results with patient data showed greater error with the 3D free-hand mode (6.50mm - 13.37mm) than with the 3D wobbler mode (2.99 ± 1.54 mm). All the measured errors were found to be in accordance to their theoretical upper bounds. CONCLUSION While both 3D volume methods showed comparable results with respect to 3D-US/3D-US registration for phantom images, for patient data registrations the 3D wobbler mode is superior to the 3D free-hand mode. The effect of all error sources could be estimated by theoretical derivations.
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Affiliation(s)
- David Iommi
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Johann Hummel
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Michael Lutz Figl
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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Camps SM, Houben T, Carneiro G, Edwards C, Antico M, Dunnhofer M, Martens EGHJ, Baeza JA, Vanneste BGL, van Limbergen EJ, de With PHN, Verhaegen F, Fontanarosa D. Automatic Quality Assessment of Transperineal Ultrasound Images of the Male Pelvic Region, Using Deep Learning. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:445-454. [PMID: 31780240 DOI: 10.1016/j.ultrasmedbio.2019.10.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/20/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
Ultrasound guidance is not in widespread use in prostate cancer radiotherapy workflows. This can be partially attributed to the need for image interpretation by a trained operator during ultrasound image acquisition. In this work, a one-class regressor, based on DenseNet and Gaussian processes, was implemented to automatically assess the quality of transperineal ultrasound images of the male pelvic region. The implemented deep learning approach was tested on 300 transperineal ultrasound images and it achieved a scoring accuracy of 94%, a specificity of 95% and a sensitivity of 92% with respect to the majority vote of 3 experts, which was comparable with the results of these experts. This is the first step toward a fully automatic workflow, which could potentially remove the need for ultrasound image interpretation and make real-time volumetric organ tracking in the radiotherapy environment using ultrasound more appealing.
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Affiliation(s)
- S M Camps
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Oncology Solutions Department, Philips Research, Eindhoven, The Netherlands
| | - T Houben
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - G Carneiro
- Australian Centre of Visual Technologies, The University of Adelaide, Adelaide, Australia
| | - C Edwards
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - M Antico
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia; School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
| | - M Dunnhofer
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - E G H J Martens
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - J A Baeza
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - B G L Vanneste
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - E J van Limbergen
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - P H N de With
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - F Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - D Fontanarosa
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia; Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
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Sayan M, Vergalasova I, Hard D, Wrigth H, Archambault J, Gagne H, Nelson C, Heimann R. Daily localization of partial breast irradiation patients with three-dimensional ultrasound imaging. Radiat Oncol J 2019; 37:259-264. [PMID: 31918463 PMCID: PMC6952713 DOI: 10.3857/roj.2019.00052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 10/21/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose Accurate localization of the lumpectomy cavity during accelerated partial breast radiation (APBR) is essential for daily setup to ensure the prescribed dose encompasses the target and avoids unnecessary irradiation to surrounding normal tissues. Three-dimensional ultrasound (3D-US) allows direct visualization of the lumpectomy cavity without additional radiation exposure. The purpose of this study was to evaluate the feasibility of 3D-US in daily target localization for APBR.Materials and methods: Forty-seven patients with stage I breast cancer who underwent breast conserving surgery were treated with a 2-week course of APBR. Patients with visible lumpectomy cavities on high quality 3D-US images were included in this analysis. Prior to each treatment, X-ray and 3D-US images were acquired and compared to images from simulation to confirm accurate position and determine shifts. Volume change of the lumpectomy cavity was determined daily with 3D-US. Results A total of 118 images of each modality from 12 eligible patients were analyzed. The average change in cavity volume was 7.8% (range, -24.1% to 14.4%) on 3D-US from simulation to the end-of-treatment. Based on 3D-US, significantly larger shifts were necessary compared to portal films in all three dimensions: anterior/posterior (p = 7E-11), left/right (p = 0.002), and superior/inferior (p = 0.004). Conclusion Given that the lumpectomy cavity is not directly visible via X-ray images, accurate positioning may not be fully achieved by X-ray images. Therefore, when the lumpectomy cavity is visible on US, 3D-US can be considered as an alternative to X-ray imaging during daily positioning for selected patients treated with APBR, thus avoiding additional exposure to ionizing radiation.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Irina Vergalasova
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Daphne Hard
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Heather Wrigth
- Department of Internal Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Jessica Archambault
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Havaleh Gagne
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Carl Nelson
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Ruth Heimann
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
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26
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Sick JT, Rancilio NJ, Fulkerson CV, Plantenga JM, Knapp DW, Stantz KM. An ultrasound based platform for image-guided radiotherapy in canine bladder cancer patients. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2019; 12:10-16. [PMID: 33458289 PMCID: PMC7807639 DOI: 10.1016/j.phro.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 11/15/2022]
Abstract
Background and purpose Ultrasound (US) is a non-invasive, non-radiographic imaging technique with high spatial and temporal resolution that can be used for localizing soft-tissue structures and tumors in real-time during radiotherapy (RT) (inter- and intra-fraction). A comprehensive approach incorporating an in-house 3D-US system within RT is presented. This system is easier to adopt into existing treatment protocols than current US based systems, with the aim of providing millimeter intra-fraction alignment errors and sensitivity to track intra-fraction bladder movement. Materials and methods An in-house integrated US manipulator and platform was designed to relate the computed tomographic (CT) scanner, 3D-US and linear accelerator coordinate systems. An agar-based phantom with measured speed of sound and densities consistent with tissues surrounding the bladder was rotated (0–45°) and translated (up to 55 mm) relative to the US and CT coordinate systems to validate this device. After acquiring and integrating CT and US images into the treatment planning system, US-to-US and US-to-CT images were co-registered to re-align the phantom relative to the linear accelerator. Results Statistical errors from US-to-US registrations for various patient orientations ranged from 0.1 to 1.7 mm for x, y, and z translation components, and 0.0–1.1° for rotational components. Statistical errors from US-to-CT registrations were 0.3–1.2 mm for the x, y and z translational components and 0.1–2.5° for the rotational components. Conclusions An ultrasound-based platform was designed, constructed and tested on a CT/US tissue-equivalent phantom to track bladder displacement with a statistical uncertainty to correct and track inter- and intra-fractional displacements of the bladder during radiation treatments.
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Affiliation(s)
- Justin T Sick
- School of Health Sciences, Purdue University, 550 Stadium Mall Drive, West Lafayette, IN 47907, USA
| | - Nicholas J Rancilio
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, 625 Harrison Street, West Lafayette, IN 47907, USA
| | - Caroline V Fulkerson
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, 625 Harrison Street, West Lafayette, IN 47907, USA
| | - Jeannie M Plantenga
- School of Health Sciences, Purdue University, 550 Stadium Mall Drive, West Lafayette, IN 47907, USA.,Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, 625 Harrison Street, West Lafayette, IN 47907, USA.,Purdue University Center for Cancer Research, Purdue University, 201 S University St, West Lafayette, IN 47906, USA
| | - Deborah W Knapp
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, 625 Harrison Street, West Lafayette, IN 47907, USA.,Purdue University Center for Cancer Research, Purdue University, 201 S University St, West Lafayette, IN 47906, USA
| | - Keith M Stantz
- School of Health Sciences, Purdue University, 550 Stadium Mall Drive, West Lafayette, IN 47907, USA.,Department of Radiology, Indiana University School of Medicine, 550 University Blvd, Indianapolis, IN, 46202, USA
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Technical note: improved positioning protocol for patient setup accuracy in conventional radiotherapy for lung cancer. Radiol Phys Technol 2019; 12:426-432. [PMID: 31549292 DOI: 10.1007/s12194-019-00537-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 12/31/2022]
Abstract
This study aimed to investigate an improved setup protocol for maintaining patient setup accuracy, with minimal or no use of image-guided radiation therapy in conventional radiotherapy for lung cancer. A coordinate value for the treatment couch in the anterior-posterior (AP) direction was obtained from the first fraction using bony anatomy image guidance. The coordinate value was invariably used for patient positioning in the second and subsequent treatment fractions. The errors of 2410 setup image sets (anterior and lateral) from 105 patients with lung cancer were analyzed. The systematic and random patient positioning errors in the AP direction were 0.6 ± 1.0 mm. Such errors accounted for 97% of all fractions within ± 2 mm. The protocol resulted in minimal patient setup errors in the AP direction using only one image for guidance; therefore, it may be applied to conventional radiotherapy for lung cancer in case of insufficient image guidance.
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Zhao W, Han B, Yang Y, Buyyounouski M, Hancock SL, Bagshaw H, Xing L. Incorporating imaging information from deep neural network layers into image guided radiation therapy (IGRT). Radiother Oncol 2019; 140:167-174. [PMID: 31302347 DOI: 10.1016/j.radonc.2019.06.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/06/2019] [Accepted: 06/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE To investigate a novel markerless prostate localization strategy using a pre-trained deep learning model to interpret routine projection kilovoltage (kV) X-ray images in image-guided radiation therapy (IGRT). MATERIALS AND METHODS We developed a personalized region-based convolutional neural network to localize the prostate treatment target without implanted fiducials. To train the deep neural network (DNN), we used the patient's planning computed tomography (pCT) images with pre-delineated prostate target to generate a large amount of synthetic kV projection X-ray images in the geometry of onboard imager (OBI) system. The DNN model was evaluated by retrospectively studying 10 patients who underwent prostate IGRT. Three out of the ten patients who had implanted fiducials and the fiducials' positions in the OBI images acquired for treatment setup were examined to show the potential of the proposed method for prostate IGRT. Statistical analysis using Lin's concordance correlation coefficient was calculated to assess the results along with the difference between the digitally reconstructed radiographs (DRR) derived and DNN predicted locations of the prostate. RESULTS Differences between the predicted target positions using DNN and their actual positions are (mean ± standard deviation) 1.58 ± 0.43 mm, 1.64 ± 0.43 mm, and 1.67 ± 0.36 mm in anterior-posterior, lateral, and oblique directions, respectively. Prostate position identified on the OBI kV images is also found to be consistent with that derived from the implanted fiducials. CONCLUSIONS Highly accurate, markerless prostate localization based on deep learning is achievable. The proposed method is useful for daily patient positioning and real-time target tracking during prostate radiotherapy.
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Affiliation(s)
- Wei Zhao
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Bin Han
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Yong Yang
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Mark Buyyounouski
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Steven L Hancock
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Hilary Bagshaw
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Lei Xing
- Stanford University, Department of Radiation Oncology, Stanford, USA.
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Lavan NA, Saran FH, Oelfke U, Mandeville HC. Adopting Advanced Radiotherapy Techniques in the Treatment of Paediatric Extracranial Malignancies: Challenges and Future Directions. Clin Oncol (R Coll Radiol) 2019; 31:50-57. [PMID: 30361128 DOI: 10.1016/j.clon.2018.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/01/2018] [Indexed: 12/25/2022]
Abstract
Geometric uncertainties in radiotherapy are conventionally addressed by defining a safety margin around the radiotherapy target. Misappropriation of such margins could result in disease recurrence from geometric miss or unnecessary irradiation of normal tissue. Numerous quantitative organ motion studies in adults have been published, but the first paediatric-specific studies were only published in recent years. In the very near future, intensity-modulated proton beam therapy and magnetic resonance-guided radiotherapy will be clinically implemented in the UK. Such techniques offer the ability to deliver radiotherapy to the pinnacle of precision and accuracy, if geometric uncertainty relating to internal organ motion and deformation can be optimally managed. The optimal margin to account for internal organ motion in children remains largely undefined. Continuing efforts to characterise motion in children and young people is necessary to optimally define safety margins and to realise the full potential of intensity-modulated radiotherapy, magnetic resonance-guided radiotherapy and intensity-modulated proton beam therapy. This overview offers a timely review of published reports on paediatric organ motion, in anticipation of the increasing application of advanced radiotherapy techniques in paediatric radiotherapy.
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Affiliation(s)
- N A Lavan
- The Institute of Cancer Research, Sutton, UK.
| | - F H Saran
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - U Oelfke
- Joint Department of Physics at the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Sutton, UK
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Zou W, Dong L, Kevin Teo BK. Current State of Image Guidance in Radiation Oncology: Implications for PTV Margin Expansion and Adaptive Therapy. Semin Radiat Oncol 2018; 28:238-247. [PMID: 29933883 DOI: 10.1016/j.semradonc.2018.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Image guidance technology has evolved and seen widespread application in the past several decades. Advancements in the diagnostic imaging field have found new applications in radiation oncology and promoted the development of therapeutic devices with advanced imaging capabilities. A recent example is the development of linear accelerators that offer magnetic resonance imaging for real-time imaging and online adaptive planning. Volumetric imaging, in particular, offers more precise localization of soft tissue targets and critical organs which reduces setup uncertainty and permit the use of smaller setup margins. We present a review of the status of current imaging modalities available for radiation oncology and its impact on target margins and use for adaptive therapy.
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Affiliation(s)
- Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA.
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Boon-Keng Kevin Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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Grimwood A, McNair HA, O'Shea TP, Gilroy S, Thomas K, Bamber JC, Tree AC, Harris EJ. In Vivo Validation of Elekta's Clarity Autoscan for Ultrasound-based Intrafraction Motion Estimation of the Prostate During Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 102:912-921. [PMID: 29859785 PMCID: PMC6202949 DOI: 10.1016/j.ijrobp.2018.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/11/2018] [Accepted: 05/11/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Our purpose was to perform an in vivo validation of ultrasound imaging for intrafraction motion estimation using the Elekta Clarity Autoscan system during prostate radiation therapy. The study was conducted as part of the Clarity-Pro trial (NCT02388308). METHODS AND MATERIALS Initial locations of intraprostatic fiducial markers were identified from cone beam computed tomography scans. Marker positions were translated according to Clarity intrafraction 3-dimensional prostate motion estimates. The updated locations were projected onto the 2-dimensional electronic portal imager plane. These Clarity-based estimates were compared with the actual portal-imaged 2-dimensional marker positions. Images from 16 patients encompassing 80 fractions were analyzed. To investigate the influence of intraprostatic markers and image quality on ultrasound motion estimation, 3 observers rated image quality, and the marker visibility on ultrasound images was assessed. RESULTS The median difference between Clarity-defined intrafraction marker locations and portal-imaged marker locations was 0.6 mm (with 95% limit of agreement at 2.5 mm). Markers were identified on ultrasound in only 3 of a possible 240 instances. No linear relationship between image quality and Clarity motion estimation confidence was identified. The difference between Clarity-based motion estimates and electronic portal-imaged marker location was also independent of image quality. Clarity estimation confidence was degraded in a single fraction owing to poor probe placement. CONCLUSIONS The accuracy of Clarity intrafraction prostate motion estimation is comparable with that of other motion-monitoring systems in radiation therapy. The effect of fiducial markers in the study was deemed negligible as they were rarely visible on ultrasound images compared with intrinsic anatomic features. Clarity motion estimation confidence was robust to variations in image quality and the number of ultrasound-imaged anatomic features; however, it was degraded as a result of poor probe placement.
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Affiliation(s)
- Alexander Grimwood
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK.
| | - Helen A McNair
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK
| | - Tuathan P O'Shea
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK
| | - Stephen Gilroy
- North West Cancer Centre, Altnagelvin Area Hospital, Londonderry, Ireland
| | - Karen Thomas
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK
| | - Jeffrey C Bamber
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK
| | - Alison C Tree
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK
| | - Emma J Harris
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital Trust, Sutton, UK
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Mori S, Knopf A, Umegaki K. Motion management in particle therapy. Med Phys 2018; 45:e994-e1010. [DOI: 10.1002/mp.12679] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/24/2017] [Accepted: 11/07/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Shinichiro Mori
- Research Center for Charged Particle Therapy National Institute of Radiological Sciences Chiba 263‐8555Japan
| | - Antje‐Christin Knopf
- Department of Radiation Oncology University of Groningen University Medical Center Groningen Groningen 9713 GZ The Netherlands
| | - Kikuo Umegaki
- Faculty of Engineering Division of Quantum Science and Engineering Hokkaido University Sapporo 060‐8628 Japan
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De Luca V, Banerjee J, Hallack A, Kondo S, Makhinya M, Nouri D, Royer L, Cifor A, Dardenne G, Goksel O, Gooding MJ, Klink C, Krupa A, Le Bras A, Marchal M, Moelker A, Niessen WJ, Papiez BW, Rothberg A, Schnabel J, van Walsum T, Harris E, Lediju Bell MA, Tanner C. Evaluation of 2D and 3D ultrasound tracking algorithms and impact on ultrasound-guided liver radiotherapy margins. Med Phys 2018; 45:4986-5003. [PMID: 30168159 DOI: 10.1002/mp.13152] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Compensation for respiratory motion is important during abdominal cancer treatments. In this work we report the results of the 2015 MICCAI Challenge on Liver Ultrasound Tracking and extend the 2D results to relate them to clinical relevance in form of reducing treatment margins and hence sparing healthy tissues, while maintaining full duty cycle. METHODS We describe methodologies for estimating and temporally predicting respiratory liver motion from continuous ultrasound imaging, used during ultrasound-guided radiation therapy. Furthermore, we investigated the trade-off between tracking accuracy and runtime in combination with temporal prediction strategies and their impact on treatment margins. RESULTS Based on 2D ultrasound sequences from 39 volunteers, a mean tracking accuracy of 0.9 mm was achieved when combining the results from the 4 challenge submissions (1.2 to 3.3 mm). The two submissions for the 3D sequences from 14 volunteers provided mean accuracies of 1.7 and 1.8 mm. In combination with temporal prediction, using the faster (41 vs 228 ms) but less accurate (1.4 vs 0.9 mm) tracking method resulted in substantially reduced treatment margins (70% vs 39%) in contrast to mid-ventilation margins, as it avoided non-linear temporal prediction by keeping the treatment system latency low (150 vs 400 ms). Acceleration of the best tracking method would improve the margin reduction to 75%. CONCLUSIONS Liver motion estimation and prediction during free-breathing from 2D ultrasound images can substantially reduce the in-plane motion uncertainty and hence treatment margins. Employing an accurate tracking method while avoiding non-linear temporal prediction would be favorable. This approach has the potential to shorten treatment time compared to breath-hold and gated approaches, and increase treatment efficiency and safety.
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Affiliation(s)
- Valeria De Luca
- Computer Vision Laboratory, ETH Zurich, Zürich, Switzerland
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | | | - Andre Hallack
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | | | - Maxim Makhinya
- Computer Vision Laboratory, ETH Zurich, Zürich, Switzerland
| | | | - Lucas Royer
- Institut de Recherche Technologique b-com, Rennes, France
| | | | | | - Orcun Goksel
- Computer Vision Laboratory, ETH Zurich, Zürich, Switzerland
| | | | - Camiel Klink
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Maud Marchal
- Institut de Recherche Technologique b-com, Rennes, France
| | - Adriaan Moelker
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Wiro J Niessen
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Julia Schnabel
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Theo van Walsum
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Muyinatu A Lediju Bell
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, USA
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Mostafaei F, Tai A, Gore E, Johnstone C, Haase W, Ehlers C, Cooper DT, Lachaine M, Li XA. Feasibility of real-time lung tumor motion monitoring using intrafractional ultrasound and kV cone beam projection images. Med Phys 2018; 45:4619-4626. [DOI: 10.1002/mp.13104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Farshad Mostafaei
- Department of Radiation Oncology; Medical College of Wisconsin; Milwaukee WI 53226 USA
| | - An Tai
- Department of Radiation Oncology; Medical College of Wisconsin; Milwaukee WI 53226 USA
| | - Elizabeth Gore
- Department of Radiation Oncology; Medical College of Wisconsin; Milwaukee WI 53226 USA
| | - Candice Johnstone
- Department of Radiation Oncology; Medical College of Wisconsin; Milwaukee WI 53226 USA
| | - William Haase
- Department of Radiation Oncology; Medical College of Wisconsin; Milwaukee WI 53226 USA
| | - Christopher Ehlers
- Department of Radiology; Medical College of Wisconsin; Milwaukee WI 53226 USA
| | | | | | - X. Allen Li
- Department of Radiation Oncology; Medical College of Wisconsin; Milwaukee WI 53226 USA
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Meyer P, Noblet V, Mazzara C, Lallement A. Survey on deep learning for radiotherapy. Comput Biol Med 2018; 98:126-146. [PMID: 29787940 DOI: 10.1016/j.compbiomed.2018.05.018] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 12/17/2022]
Abstract
More than 50% of cancer patients are treated with radiotherapy, either exclusively or in combination with other methods. The planning and delivery of radiotherapy treatment is a complex process, but can now be greatly facilitated by artificial intelligence technology. Deep learning is the fastest-growing field in artificial intelligence and has been successfully used in recent years in many domains, including medicine. In this article, we first explain the concept of deep learning, addressing it in the broader context of machine learning. The most common network architectures are presented, with a more specific focus on convolutional neural networks. We then present a review of the published works on deep learning methods that can be applied to radiotherapy, which are classified into seven categories related to the patient workflow, and can provide some insights of potential future applications. We have attempted to make this paper accessible to both radiotherapy and deep learning communities, and hope that it will inspire new collaborations between these two communities to develop dedicated radiotherapy applications.
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Affiliation(s)
- Philippe Meyer
- Department of Medical Physics, Paul Strauss Center, Strasbourg, France.
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Camps SM, Verhaegen F, Vanneste BGL, de With PHN, Fontanarosa D. Automated patient-specific transperineal ultrasound probe setups for prostate cancer patients undergoing radiotherapy. Med Phys 2018; 45:3185-3195. [PMID: 29757474 DOI: 10.1002/mp.12972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 05/04/2018] [Accepted: 05/04/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The use of ultrasound imaging is not widespread in prostate cancer radiotherapy workflows, despite several advantages (eg, allowing real-time volumetric organ tracking). This can be partially attributed to the need for a trained operator during acquisition and interpretation of the images. We introduce and evaluate an algorithm that can propose a patient-specific transperineal ultrasound probe setup, based on a CT scan and anatomical structure delineations. The use of this setup during the simulation and treatment stage could improve usability of ultrasound imaging for relatively untrained operators (radiotherapists with less than 1 yr experience with ultrasound). METHODS The internal perineum boundaries of three prostate cancer patients were identified based on bone masks extracted from their CT scans. After projection of these boundaries to the skin and exclusion of specific areas, this resulted in a skin area accessible for transperineal ultrasound probe placement in clinical practice. Several possible probe setups on this area were proposed by the algorithm and the optimal setup was automatically selected. In the end, this optimal setup was evaluated based on a comparison with a corresponding transperineal ultrasound volume acquired by a radiation oncologist. RESULTS The algorithm-proposed setups allowed visualization of 100% of the clinically required anatomical structures, including the whole prostate and seminal vesicles, as well as the adjacent edges of the bladder and rectum. In addition, these setups allowed visualization of 94% of the anatomical structures, which were also visualized by the physician during the acquisition of an actual ultrasound volume. CONCLUSION Provided that the ultrasound probe setup proposed by the algorithm, is properly reproduced on the patient, it allows visualization of all clinically required structures for image guided radiotherapy purposes. Future work should validate these results on a patient population and optimize the workflow to enable a relatively untrained operator to perform the procedure.
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Affiliation(s)
- Saskia Maria Camps
- Faculty of Electrical Engineering, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands.,Oncology Solutions Department, Philips Research, 5656 AE, Eindhoven, The Netherlands
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, 6229 ET, Maastricht, The Netherlands
| | - Ben G L Vanneste
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, 6229 ET, Maastricht, The Netherlands
| | - Peter H N de With
- Faculty of Electrical Engineering, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
| | - Davide Fontanarosa
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Qld, 4000, Australia.,Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Qld, 4059, Australia
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Chiu TD, Parsons D, Zhang Y, Hrycushko B, Zhao B, Chopra R, Kim N, Spangler A, Rahimi A, Timmerman R, Jiang SB, Lu W, Gu X. Prototype volumetric ultrasound tomography image guidance system for prone stereotactic partial breast irradiation: proof-of-concept. Phys Med Biol 2018; 63:055004. [PMID: 29405123 DOI: 10.1088/1361-6560/aaad1f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Accurate dose delivery in stereotactic partial breast irradiation (S-PBI) is challenging because of the target position uncertainty caused by breast deformation, the target volume changes caused by lumpectomy cavity shrinkage, and the target delineation uncertainty on simulation computed tomography (CT) images caused by poor soft tissue contrast. We have developed a volumetric ultrasound tomography (UST) image guidance system for prone position S-PBI. The system is composed of a novel 3D printed rotation water tank, a patient-specific resin breast immobilization cup, and a 1D array ultrasound transducer. Coronal 2D US images were acquired in 5° increments over a 360° range, and planes were acquired every 2 mm in elevation. A super-compounding technique was used to reconstruct the image volume. The image quality of UST was evaluated with a BB-1 breast phantom and BioZorb surgical marker, and the results revealed that UST offered better soft tissue contrast than CT and similar image quality to MR. In the evaluated plane, the size and location of five embedded objects were measured and compared to MR, which is considered as the ground truth. Objects' diameters and the distances between objects in UST differ by approximately 1 to 2 mm from those in MR, which showed that UST offers the image quality required for S-PBI. In future work we will develop a robotic system that will be ultimately implemented in the clinic.
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Affiliation(s)
- Tsuicheng D Chiu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America. Tsuicheng Chiu and David Parsons contributed equally to this study
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Towards a Clinical Decision Support System for External Beam Radiation Oncology Prostate Cancer Patients: Proton vs. Photon Radiotherapy? A Radiobiological Study of Robustness and Stability. Cancers (Basel) 2018; 10:cancers10020055. [PMID: 29463018 PMCID: PMC5836087 DOI: 10.3390/cancers10020055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/19/2018] [Accepted: 02/14/2018] [Indexed: 12/25/2022] Open
Abstract
We present a methodology which can be utilized to select proton or photon radiotherapy in prostate cancer patients. Four state-of-the-art competing treatment modalities were compared (by way of an in silico trial) for a cohort of 25 prostate cancer patients, with and without correction strategies for prostate displacements. Metrics measured from clinical image guidance systems were used. Three correction strategies were investigated; no-correction, extended-no-action-limit, and online-correction. Clinical efficacy was estimated via radiobiological models incorporating robustness (how probable a given treatment plan was delivered) and stability (the consistency between the probable best and worst delivered treatments at the 95% confidence limit). The results obtained at the cohort level enabled the determination of a threshold for likely clinical benefit at the individual level. Depending on the imaging system and correction strategy; 24%, 32% and 44% of patients were identified as suitable candidates for proton therapy. For the constraints of this study: Intensity-modulated proton therapy with online-correction was on average the most effective modality. Irrespective of the imaging system, each treatment modality is similar in terms of robustness, with and without the correction strategies. Conversely, there is substantial variation in stability between the treatment modalities, which is greatly reduced by correction strategies. This study provides a ‘proof-of-concept’ methodology to enable the prospective identification of individual patients that will most likely (above a certain threshold) benefit from proton therapy.
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The Use of Ultrasound Imaging in the External Beam Radiotherapy Workflow of Prostate Cancer Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7569590. [PMID: 29619375 PMCID: PMC5829356 DOI: 10.1155/2018/7569590] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/13/2017] [Accepted: 12/28/2017] [Indexed: 12/16/2022]
Abstract
External beam radiotherapy (EBRT) is one of the curative treatment options for prostate cancer patients. The aim of this treatment option is to irradiate tumor tissue, while sparing normal tissue as much as possible. Frequent imaging during the course of the treatment (image guided radiotherapy) allows for determination of the location and shape of the prostate (target) and of the organs at risk. This information is used to increase accuracy in radiation dose delivery resulting in better tumor control and lower toxicity. Ultrasound imaging is harmless for the patient, it is cost-effective, and it allows for real-time volumetric organ tracking. For these reasons, it is an ideal technique for image guidance during EBRT workflows. Review papers have been published in which the use of ultrasound imaging in EBRT workflows for different cancer sites (prostate, breast, etc.) was extensively covered. This new review paper aims at providing the readers with an update on the current status for prostate cancer ultrasound guided EBRT treatments.
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40
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Richardson A, Jacobs P. Intrafraction monitoring of prostate motion during radiotherapy using the Clarity ® Autoscan Transperineal Ultrasound (TPUS) system. Radiography (Lond) 2017; 23:310-313. [DOI: 10.1016/j.radi.2017.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/13/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
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Kim J, Park EY, Jung Y, Kim BC, Kim JH, Yi CY, Kim IJ, Kim C. X-Ray Acoustic-Based Dosimetry Using a Focused Ultrasound Transducer and a Medical Linear Accelerator. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2017. [DOI: 10.1109/trpms.2017.2757484] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Shepard AJ, Wang B, Foo TKF, Bednarz BP. A block matching based approach with multiple simultaneous templates for the real-time 2D ultrasound tracking of liver vessels. Med Phys 2017; 44:5889-5900. [PMID: 28898419 DOI: 10.1002/mp.12574] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/15/2017] [Accepted: 08/20/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The implementation of motion management techniques in radiation therapy can aid in mitigating uncertainties and reducing margins. For motion management to be effective, it is necessary to track key structures both accurately and at a real-time speed. Therefore, the focus of this work was to develop a 2D algorithm for the real-time tracking of ultrasound features to aid in radiation therapy motion management. MATERIALS AND METHODS The developed algorithm utilized a similarity measure-based block matching algorithm incorporating training methods and multiple simultaneous templates. The algorithm is broken down into three primary components, all of which use normalized cross-correlation (NCC) as a similarity metric. First, a global feature shift to account for gross displacements from the previous frame is determined using large block sizes which encompass the entirety of the feature. Second, the most similar reference frame is chosen from a series of training images that are accumulated during the first K frames of tracking to aid in contour consistency and provide a starting point for the localized template initialization. Finally, localized block matching is performed through the simultaneous use of both a training frame and the previous frame. The localized block matching utilizes a series of templates positioned at the boundary points of the training and previous contours. The weighted final boundary points from both the previous and the training frame are ultimately combined and used to determine an affine transformation from the previous frame to the current frame. RESULTS A mean tracking error of 0.72 ± 1.25 mm was observed for 85 point-landmarks across 39 ultrasound sequences relative to manual ground truth annotations. The image processing speed per landmark with the GPU implementation was between 41 and 165 frames per second (fps) during the training set accumulation, and between 73 and 234 fps after training set accumulation. Relative to a comparable multithreaded CPU approach using OpenMP, the GPU implementation resulted in speedups between -30% and 355% during training set accumulation, and between -37% and 639% postaccumulation. CONCLUSIONS Initial implementations indicated an accuracy that was comparable to or exceeding those achieved by alternative 2D tracking methods, with a computational speed that is more than sufficient for real-time applications in a radiation therapy environment. While the overall performance reached levels suitable for implementation in radiation therapy, the observed increase in failures for smaller features, as well as the algorithm's inability to be applied to nonconvex features warrants additional investigation to address the shortcomings observed.
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Affiliation(s)
- Andrew J Shepard
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, USA
| | - Bo Wang
- GE Global Research, 1 Research Cir, Niskayuna, NY, 12309, USA
| | - Thomas K F Foo
- GE Global Research, 1 Research Cir, Niskayuna, NY, 12309, USA
| | - Bryan P Bednarz
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, USA
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Martyn M, O'Shea TP, Harris E, Bamber J, Gilroy S, Foley MJ. A Monte Carlo study of the effect of an ultrasound transducer on surface dose during intrafraction motion imaging for external beam radiation therapy. Med Phys 2017; 44:5020-5033. [PMID: 28688115 DOI: 10.1002/mp.12464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/19/2017] [Accepted: 07/04/2017] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this study was to estimate changes in surface dose due to the presence of the Clarity Autoscan™ ultrasound (US) probe during prostate radiotherapy using Monte Carlo (MC) methods. METHODS MC models of the Autoscan US probe were developed using the BEAMnrc/DOSXYZnrc code based on kV and MV CT images. CT datasets were converted to voxelized mass density phantoms using a CT number-to-mass density calibration. The dosimetric effect of the probe, in the contact region (an 8 mm × 12 mm single layer of voxels), was investigated using a phantom set-up mimicking two scenarios (a) a transperineal imaging configuration (radiation beam perpendicular to the central US axial direction), and (b) a transabdominal imaging configuration (radiation beam parallel to the central US axial direction). For scenario (a), the dosimetric effect was evaluated as a function of the probe to inferior radiation field edge distance. Clinically applicable distances from 5 mm separation to 2 mm overlap were determined from the radiotherapy plans of 27 patients receiving Clarity imaging. Overlaps of 3 to 14 (1 to 3 SD) mm were also considered to include the effect of interfraction motion correction. The influence of voxel size on surface dose estimation was investigated. Approved clinical plans from two prostate patients were used to simulate worst-case dosimetric impact of the probe when large couch translations were applied to correct for interfraction prostate motion. RESULTS The dosimetric impact of both the MV and kV probe models agreed within ±2% for both beam configurations. For scenario (a) and 1 mm voxel model, the probe gave mean dose increases of 1.2% to 4.6% (of the dose at isocenter) for 5 mm separation to 0 mm overlap in the probe-phantom contact region, respectively. This increased to 27.5% for the largest interfraction motion correction considered (14 mm overlap). For separations of ≥ 2 mm dose differences were < 2%. Simulated dose perturbations were found to be superficial; for the 14 mm overlap the dose increase reduced to < 3% at 5.0 mm within the phantom. For scenario (b), dose increases due to the probe were < 5% in all cases. The dose increase was underestimated by up to ~13% when the voxel size was increased from 1 mm to 3 mm. MC simulated dose to the PTV and OARs for the two clinical plans considered showed good agreement with commercial treatment planning system results (within 2%). Mean dose increases due to the presence of the probe, after the maximum interfraction motion correction, were ~16.3% and ~8.0%, in the contact region, for plan 1 and plan 2, respectively. CONCLUSIONS The presence of the probe results in superficial dose perturbations for patients with an overlap between the probe and the radiation field present in either the original treatment plan or due to translation of the radiation field to simulate correction of interfraction internal prostate motion.
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Affiliation(s)
- Michael Martyn
- School of Physics, National University of Ireland Galway, University Road, Galway, Ireland
| | - Tuathan P O'Shea
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Emma Harris
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Jeffrey Bamber
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Stephen Gilroy
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Mark J Foley
- School of Physics, National University of Ireland Galway, University Road, Galway, Ireland
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Abstract
Artifacts are frequently encountered at clinical US, and while some are unwanted, others may reveal valuable information related to the structure and composition of the underlying tissue. They are essential in making ultrasonography (US) a clinically useful imaging modality but also can lead to errors in image interpretation and can obscure diagnoses. Many of these artifacts can be understood as deviations from the assumptions made in generating the image. Therefore, understanding the physical basis of US image formation is critical to understanding US artifacts and thus proper image interpretation. This review is limited to gray-scale artifacts and is organized into discussions of beam- and resolution-related, location-related (ie, path and speed), and attenuation-related artifacts. Specifically, artifacts discussed include those related to physical mechanisms of spatial resolution, speckle, secondary lobes, reflection and reverberation, refraction, speed of sound, and attenuation. The underlying physical mechanisms and appearances are discussed, followed by real-world strategies to mitigate or accentuate these artifacts, depending on the clinical application. Relatively new US modes, such as spatial compounding, tissue harmonic imaging, and speckle reduction imaging, are now often standard in many imaging protocols; the effects of these modes on US artifacts are discussed. The ability of a radiologist to understand the fundamental physics of ultrasound, recognize common US artifacts, and provide recommendations for altering the imaging technique is essential for proper image interpretation, troubleshooting, and utilization of the full potential of this modality. ©RSNA, 2017.
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Affiliation(s)
- Michael Baad
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637
| | - Zheng Feng Lu
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637
| | - Ingrid Reiser
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637
| | - David Paushter
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637
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45
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Gerlach S, Kuhlemann I, Ernst F, Fürweger C, Schlaefer A. Impact of robotic ultrasound image guidance on plan quality in SBRT of the prostate. Br J Radiol 2017; 90:20160926. [PMID: 28749165 DOI: 10.1259/bjr.20160926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Ultrasound provides good image quality, fast volumetric imaging and is established for abdominal image guidance. Robotic transducer placement may facilitate intrafractional motion compensation in radiation therapy. We consider integration with the CyberKnife and study whether the kinematic redundancy of a seven-degrees-of-freedom robot allows for acceptable plan quality for prostate treatments. METHODS Reference treatment plans were generated for 10 prostate cancer cases previously treated with the CyberKnife. Considering transducer and prostate motion by different safety margins, 10 different robot poses, and 3 different elbow configurations, we removed all beams colliding with robot or transducer. For each combination, plans were generated using the same strict dose constraints and the objective to maximize the target coverage. Additionally, plans for the union of all unblocked beams were generated. RESULTS In 9 cases the planning target coverage with the ultrasound robot was within 1.1 percentage points of the reference coverage. It was 1.7 percentage points for one large prostate. For one preferable robot position, kinematic redundancy decreased the average number of blocked beam directions from 23.1 to 14.5. CONCLUSION The impact of beam blocking can largely be offset by treatment planning and using a kinematically redundant robot. Plan quality can be maintained by carefully choosing the ultrasound robot position and pose. For smaller planning target volumes the difference in coverage is negligible for safety margins of up to 35 mm. Advances in knowledge: Integrating a robot for online intrafractional image guidance based on ultrasound can be realized while maintaining acceptable plan quality for prostate cancer treatments with the CyberKnife.
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Affiliation(s)
- Stefan Gerlach
- 1 Institute of Medical Technology, Hamburg University of Technology, Hamburg, Germany
| | - Ivo Kuhlemann
- 2 Institute for Robotics and Cognitive Systems, Universität zu Lübeck, Lübeck, Germany
| | - Floris Ernst
- 2 Institute for Robotics and Cognitive Systems, Universität zu Lübeck, Lübeck, Germany
| | | | - Alexander Schlaefer
- 1 Institute of Medical Technology, Hamburg University of Technology, Hamburg, Germany
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Development of an in vitro diaphragm motion reproduction system. Phys Med 2017; 39:39-49. [DOI: 10.1016/j.ejmp.2017.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/11/2017] [Accepted: 06/15/2017] [Indexed: 12/25/2022] Open
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Mason SA, O’Shea TP, White IM, Lalondrelle S, Downey K, Baker M, Behrens CF, Bamber JC, Harris EJ. Towards ultrasound-guided adaptive radiotherapy for cervical cancer: Evaluation of Elekta's semiautomated uterine segmentation method on 3D ultrasound images. Med Phys 2017; 44:3630-3638. [PMID: 28493295 PMCID: PMC5575494 DOI: 10.1002/mp.12325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/10/2017] [Accepted: 03/29/2017] [Indexed: 11/06/2022] Open
Abstract
PURPOSE 3D ultrasound (US) images of the uterus may be used to adapt radiotherapy (RT) for cervical cancer patients based on changes in daily anatomy. This requires accurate on-line segmentation of the uterus. The aim of this work was to assess the accuracy of Elekta's "Assisted Gyne Segmentation" (AGS) algorithm in semi-automatically segmenting the uterus on 3D transabdominal ultrasound images by comparison with manual contours. MATERIALS & METHODS Nine patients receiving RT for cervical cancer were imaged with the 3D Clarity® transabdominal probe at RT planning, and 1 to 7 times during treatment. Image quality was rated from unusable (0)-excellent (3). Four experts segmented the uterus (defined as the uterine body and cervix) manually and using AGS on images with a ranking > 0. Pairwise analysis between manual contours was evaluated to determine interobserver variability. The accuracy of the AGS method was assessed by measuring its agreement with manual contours via pairwise analysis. RESULTS 35/44 images acquired (79.5%) received a ranking > 0. For the manual contour variation, the median [interquartile range (IQR)] distance between centroids (DC) was 5.41 [5.0] mm, the Dice similarity coefficient (DSC) was 0.78 [0.11], the mean surface-to-surface distance (MSSD) was 3.20 [1.8] mm, and the uniform margin of 95% (UM95) was 4.04 [5.8] mm. There was no correlation between image quality and manual contour agreement. AGS failed to give a result in 19.3% of cases. For the remaining cases, the level of agreement between AGS contours and manual contours depended on image quality. There were no significant differences between the AGS segmentations and the manual segmentations on the images that received a quality rating of 3. However, the AGS algorithm had significantly worse agreement with manual contours on images with quality ratings of 1 and 2 compared with the corresponding interobserver manual variation. The overall median [IQR] DC, DSC, MSSD, and UM95 between AGS and manual contours was 5.48 [5.45] mm, 0.77 [0.14], 3.62 [2.7] mm, and 5.19 [8.1] mm, respectively. CONCLUSIONS The AGS tool was able to represent uterine shape of cervical cancer patients in agreement with manual contouring in cases where the image quality was excellent, but not in cases where image quality was degraded by common artifacts such as shadowing and signal attenuation. The AGS tool should be used with caution for adaptive RT purposes, as it is not reliable in accurately segmenting the uterus on 'good' or 'poor' quality images. The interobserver agreement between manual contours of the uterus drawn on 3D US was consistent with results of similar studies performed on CT and MRI images.
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Affiliation(s)
- Sarah A. Mason
- Joint Department of Physics at the Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton and LondonUK
| | - Tuathan P. O’Shea
- Joint Department of Physics at the Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton and LondonUK
| | - Ingrid M. White
- Joint Department of Physics at the Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton and LondonUK
| | - Susan Lalondrelle
- Joint Department of Physics at the Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton and LondonUK
| | - Kate Downey
- Joint Department of Physics at the Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton and LondonUK
| | - Mariwan Baker
- Department of OncologyHerlev Hospital, University of CopenhagenHerlevDenmark
| | - Claus F. Behrens
- Department of OncologyHerlev Hospital, University of CopenhagenHerlevDenmark
| | - Jeffrey C. Bamber
- Joint Department of Physics at the Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton and LondonUK
| | - Emma J. Harris
- Joint Department of Physics at the Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton and LondonUK
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Su L, Iordachita I, Zhang Y, Lee J, Ng SK, Jackson J, Hooker T, Wong J, Herman JM, Sen HT, Kazanzides P, Lediju Bell MA, Yang C, Ding K. Feasibility study of ultrasound imaging for stereotactic body radiation therapy with active breathing coordinator in pancreatic cancer. J Appl Clin Med Phys 2017; 18:84-96. [PMID: 28574192 PMCID: PMC5529166 DOI: 10.1002/acm2.12100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/20/2016] [Accepted: 03/31/2017] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) allows for high radiation doses to be delivered to the pancreatic tumors with limited toxicity. Nevertheless, the respiratory motion of the pancreas introduces major uncertainty during SBRT. Ultrasound imaging is a non-ionizing, non-invasive, and real-time technique for intrafraction monitoring. A configuration is not available to place the ultrasound probe during pancreas SBRT for monitoring. METHODS AND MATERIALS An arm-bridge system was designed and built. A CT scan of the bridge-held ultrasound probe was acquired and fused to ten previously treated pancreatic SBRT patient CTs as virtual simulation CTs. Both step-and-shoot intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) planning were performed on virtual simulation CT. The accuracy of our tracking algorithm was evaluated by programmed motion phantom with simulated breath-hold 3D movement. An IRB-approved volunteer study was also performed to evaluate feasibility of system setup. Three healthy subjects underwent the same patient setup required for pancreas SBRT with active breath control (ABC). 4D ultrasound images were acquired for monitoring. Ten breath-hold cycles were monitored for both phantom and volunteers. For the phantom study, the target motion tracked by ultrasound was compared with motion tracked by the infrared camera. For the volunteer study, the reproducibility of ABC breath-hold was assessed. RESULTS The volunteer study results showed that the arm-bridge system allows placement of an ultrasound probe. The ultrasound monitoring showed less than 2 mm reproducibility of ABC breath-hold in healthy volunteers. The phantom monitoring accuracy is 0.14 ± 0.08 mm, 0.04 ± 0.1 mm, and 0.25 ± 0.09 mm in three directions. On dosimetry part, 100% of virtual simulation plans passed protocol criteria. CONCLUSIONS Our ultrasound system can be potentially used for real-time monitoring during pancreas SBRT without compromising planning quality. The phantom study showed high monitoring accuracy of the system, and the volunteer study showed feasibility of the clinical workflow.
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Affiliation(s)
- Lin Su
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Iulian Iordachita
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Yin Zhang
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Junghoon Lee
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Sook Kien Ng
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Juan Jackson
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Ted Hooker
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - John Wong
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph M Herman
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - H Tutkun Sen
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Kazanzides
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | | | - Chen Yang
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.,Department of Ultrasound, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Kai Ding
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
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Omari EA, Erickson B, Ehlers C, Quiroz F, Noid G, Cooper DT, Lachaine M, Li XA. Preliminary results on the feasibility of using ultrasound to monitor intrafractional motion during radiation therapy for pancreatic cancer. Med Phys 2017; 43:5252. [PMID: 27587056 DOI: 10.1118/1.4960004] [Citation(s) in RCA: 14] [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 Substantial intrafraction organ motion during radiation therapy (RT) for pancreatic cancer is well recognized as a major limiting factor for accurate delivery of RT. The aim of this work is to determine the feasibility of monitoring the intrafractional motion of the pancreas or surrounding structures using ultrasound for RT delivery. METHODS Transabdominal ultrasound (TAUS) and 4DCT data were acquired on ten pancreatic cancer patients during radiation therapy process in a prospective study. In addition, TAUS and MRI were collected for five healthy volunteers. The portal vein (PV) and the head of the pancreas (HP) along with other structures were contoured on these images. Volume changes, distance between the HP and PV, and motion difference between the HP and PV were measured to examine whether PV can be used as a motion surrogate for HP. TAUS images were acquired and processed using a research version of the Clarity autoscan ultrasound system (CAUS). Motion monitoring was performed with the ultrasound probe mounted on an arm fixed to the couch. Video segments of the monitoring sessions were captured. RESULTS On TAUS, PV is better visualized than HP. The measured mean volume deviation for all patients for the HP and PV was 1.4 and 0.6 ml, respectively. The distance between the HP and PV was close to a constant with 0.22 mm mean deviation throughout the ten breathing phases. The mean of the absolute motion difference for all patients was 1.7 ± 0.8 mm in LR, 1.5 ± 0.5 mm in AP, and 2.3 ± 0.7 mm in SI, suggesting that the PV is a good surrogate for HP motion estimation. By using this surrogate, the HP motion tracking using TAUS was demonstrated. CONCLUSIONS Large intrafractional organ motion due to respiratory and/or bowel motion is a limiting factor in administering curative radiation doses to pancreatic tumors. The authors investigate the use of real-time ultrasound to track pancreas motion. Due to the poor visibility of the pancreas head on an ultrasound image, the portal vein is identified as a surrogate. The authors have demonstrated the feasibility of tracking HP motion through the localization of the PV using TAUS. This will potentially allow real-time tracking of intrafractional motion to justify small PTV-margins and to account for unusual motions, thus, improving normal tissue sparing.
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Affiliation(s)
- Eenas A Omari
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Christopher Ehlers
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Francisco Quiroz
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - George Noid
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | | | | | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
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Comparison of 2 transabdominal ultrasound image guidance techniques for prostate and prostatic fossa radiation therapy. Pract Radiat Oncol 2017; 7:e99-e107. [PMID: 28274407 DOI: 10.1016/j.prro.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/09/2016] [Accepted: 07/05/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Our clinic is a long-term user of a first-generation transabdominal (TA) biplanar (2.5-dimensional [2.5D]) ultrasound image guidance (USIG) system for prostate cancer treatments. We are also an early adopter and development partner for a new, second-generation, fully 3D USIG system that allows for volumetric TA localization of the prostate. This new system has been evaluated at our institution by direct comparison with the previously established first-generation TA method for prostate alignment. METHODS AND MATERIALS We compared the 2 TA-USIG methods on the same subjects and same treatment sessions. A total of 1428 fractions delivered to 41 treated patients (16 intact prostate, 25 fossa) were analyzed regarding the agreement of alignments between the 2 US positioning systems. Patients were first aligned to tattoos using treatment room lasers. TA-USIG using the 3D system was then performed to align contours derived during the computed tomography simulation process to their corresponding daily US-visualized structures. The US-3D system image guidance shifts were performed and recorded as the "initial" shifts. A 2.5D system alignment was then immediately performed using the same computed tomography derived reference contours and the indicated shifts, relative to the 3D system, were recorded as the difference between the 2 alignment methods. RESULTS The average difference between the 2 TA-USIG alignments for all patients was 0.4 ± 0.7 mm, 0.7 ± 0.9 mm, and 0.5 ± 0.9 mm in the left-right, anteroposterior, and superoinferior directions, respectively. No significant difference in system agreement between intact prostate versus fossa patients was observed. CONCLUSION Our comparison of an established 2.5D USIG method with a newer, fully 3D approach for prostate alignment of 41 different patients (1428 fractions) shows excellent agreement with each other, despite the nontrivial difference in imaging approaches. This shows that the 2 specific USIG approaches yield results that are consistent with each other, and that the USIG modality yields consistent results within the modality.
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