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Zhang Y, Jiang Z, Zhang Y, Ren L. A review on 4D cone-beam CT (4D-CBCT) in radiation therapy: Technical advances and clinical applications. Med Phys 2024. [PMID: 38922912 DOI: 10.1002/mp.17269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/05/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
Cone-beam CT (CBCT) is the most commonly used onboard imaging technique for target localization in radiation therapy. Conventional 3D CBCT acquires x-ray cone-beam projections at multiple angles around the patient to reconstruct 3D images of the patient in the treatment room. However, despite its wide usage, 3D CBCT is limited in imaging disease sites affected by respiratory motions or other dynamic changes within the body, as it lacks time-resolved information. To overcome this limitation, 4D-CBCT was developed to incorporate a time dimension in the imaging to account for the patient's motion during the acquisitions. For example, respiration-correlated 4D-CBCT divides the breathing cycles into different phase bins and reconstructs 3D images for each phase bin, ultimately generating a complete set of 4D images. 4D-CBCT is valuable for localizing tumors in the thoracic and abdominal regions where the localization accuracy is affected by respiratory motions. This is especially important for hypofractionated stereotactic body radiation therapy (SBRT), which delivers much higher fractional doses in fewer fractions than conventional fractionated treatments. Nonetheless, 4D-CBCT does face certain limitations, including long scanning times, high imaging doses, and compromised image quality due to the necessity of acquiring sufficient x-ray projections for each respiratory phase. In order to address these challenges, numerous methods have been developed to achieve fast, low-dose, and high-quality 4D-CBCT. This paper aims to review the technical developments surrounding 4D-CBCT comprehensively. It will explore conventional algorithms and recent deep learning-based approaches, delving into their capabilities and limitations. Additionally, the paper will discuss the potential clinical applications of 4D-CBCT and outline a future roadmap, highlighting areas for further research and development. Through this exploration, the readers will better understand 4D-CBCT's capabilities and potential to enhance radiation therapy.
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Affiliation(s)
- Yawei Zhang
- Department of Radiation Oncology, University of Florida Health Proton Therapy Institute, Jacksonville, Florida, USA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Zhuoran Jiang
- Medical Physics Graduate Program, Duke University, Durham, North Carolina, USA
| | - You Zhang
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Lei Ren
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA
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Oh J, Koo S. Fast digitally reconstructed radiograph generation using particle-based statistical shape and intensity model. J Med Imaging (Bellingham) 2024; 11:033503. [PMID: 38910836 PMCID: PMC11192206 DOI: 10.1117/1.jmi.11.3.033503] [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: 10/27/2023] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Statistical shape and intensity models (SSIMs) and digitally reconstructed radiographs (DRRs) were introduced for non-rigid 2D-3D registration and skeletal geometry/density reconstruction studies. The computation of DRRs takes most of the time during registration or reconstruction. The goal of this study is to propose a particle-based method for composing an SSIM and a DRR image generation scheme and analyze the quality of the images compared with previous DRR generation methods. Approach Particle-based SSIMs consist of densely scattered particles on the surface and inside of an object, with each particle having an intensity value. Generating the DRR resembles ray tracing, which counts the particles that are binned with each ray and calculates the radiation attenuation. The distance between adjacent particles was considered to be the radiologic path during attenuation integration, and the mean linear attenuation coefficient of the two particles was multiplied. The proposed method was compared with the DRR of CT projection. The mean squared error and peak signal-to-noise ratio (PSNR) were calculated between the DRR images from the proposed method and those of existing methods of projecting tetrahedral-based SSIMs or computed tomography (CT) images to verify the accuracy of the proposed scheme. Results The suggested method was about 600 times faster than the tetrahedral-based SSIM without using the hardware acceleration technique. The PSNR was 37.59 dB, and the root mean squared error of the normalized pixel intensities was 0.0136. Conclusions The proposed SSIM and DRR generation procedure showed high temporal performance while maintaining image quality, and particle-based SSIM is a feasible form for representing a 3D volume and generating the DRR images.
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Affiliation(s)
- Jeongseok Oh
- Korea Advanced Institute of Science and Technology, Department of Mechanical Engineering, Daejeon, Republic of Korea
| | - Seungbum Koo
- Korea Advanced Institute of Science and Technology, Department of Mechanical Engineering, Daejeon, Republic of Korea
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Vergalasova I, Cai J. A modern review of the uncertainties in volumetric imaging of respiratory-induced target motion in lung radiotherapy. Med Phys 2020; 47:e988-e1008. [PMID: 32506452 DOI: 10.1002/mp.14312] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/15/2020] [Accepted: 05/26/2020] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy has become a critical component for the treatment of all stages and types of lung cancer, often times being the primary gateway to a cure. However, given that radiation can cause harmful side effects depending on how much surrounding healthy tissue is exposed, treatment of the lung can be particularly challenging due to the presence of moving targets. Careful implementation of every step in the radiotherapy process is absolutely integral for attaining optimal clinical outcomes. With the advent and now widespread use of stereotactic body radiation therapy (SBRT), where extremely large doses are delivered, accurate, and precise dose targeting is especially vital to achieve an optimal risk to benefit ratio. This has largely become possible due to the rapid development of image-guided technology. Although imaging is critical to the success of radiotherapy, it can often be plagued with uncertainties due to respiratory-induced target motion. There has and continues to be an immense research effort aimed at acknowledging and addressing these uncertainties to further our abilities to more precisely target radiation treatment. Thus, the goal of this article is to provide a detailed review of the prevailing uncertainties that remain to be investigated across the different imaging modalities, as well as to highlight the more modern solutions to imaging motion and their role in addressing the current challenges.
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Affiliation(s)
- Irina Vergalasova
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Aoki S, Yamashita H, Haga A, Nawa K, Imae T, Takahashi W, Abe O, Nakagawa K. Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique. Oncol Lett 2018; 15:3928-3936. [PMID: 29563993 DOI: 10.3892/ol.2018.7809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/13/2017] [Indexed: 12/25/2022] Open
Abstract
The present study sought to evaluate the impact of the flattening filter-free (FFF) technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy. Its clinical safety and availability were compared with the flattening filter (FF) method. The cases of 65 patients who underwent lung volumetric modulated arc therapy-stereotactic body radiotherapy (VMAT-SBRT) using FF or FFF techniques were reviewed. A total of 55 Gy/4 fractions (fr) was prescribed for peripheral lesions or 56 Gy/7 fr for central lesions. The total monitor units (MU), treatment time, dose to tumors, dose to organs at risk, tumor control (local control rate, overall survival, progression-free survival) and adverse events between cases treated with FF and cases treated with the FFF technique were compared. A total of 35 patients were treated with conventional FF techniques prior to November 2014 and 30 patients were treated with FFF techniques after this date. It was revealed that the beam-on time was significantly shortened by the FFF technique (P<0.01). Other factors were similar for FFF and FF plans in respect to conformity (P=0.95), homogeneity (P=0.20) and other dosimetric values, including total MU and planning target volume/internal target volume coverage. The median follow-up period was 18 months (range, 2-35). One-year local control rates were 97.1 and 90.0% in the FF group and FFF groups, respectively (P=0.33). Grade 3 pneumonitis was observed in 5.8% of FF patients and 3.4% of FFF patients (P=1.00). No other adverse events ≥grade 3 were observed. The results of the study suggest that VMAT-SBRT using the FFF technique shortens the treatment time for lung SBRT while maintaining a high local control rate with low toxicity.
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Affiliation(s)
- Shuri Aoki
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Akihiro Haga
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kanabu Nawa
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Toshikazu Imae
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Wataru Takahashi
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Keiichi Nakagawa
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
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Tan Z, Liu C, Zhou Y, Shen W. Preliminary comparison of the registration effect of 4D-CBCT and 3D-CBCT in image-guided radiotherapy of Stage IA non-small-cell lung cancer. JOURNAL OF RADIATION RESEARCH 2017; 58:854-861. [PMID: 28992047 PMCID: PMC5710603 DOI: 10.1093/jrr/rrx040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/04/2017] [Indexed: 06/07/2023]
Abstract
In this study, we compared the registration effectiveness of 4D cone-beam computed tomography (CBCT) and 3D-CBCT for image-guided radiotherapy in 20 Stage IA non-small-cell lung cancer (NSCLC) patients. Patients underwent 4D-CBCT and 3D-CBCT immediately before radiotherapy, and the X-ray Volume Imaging software system was used for image registration. We performed automatic bone registration and soft tissue registration between 4D-CBCT or 3D-CBCT and 4D-CT images; the regions of interest (ROIs) were the vertebral body on the layer corresponding to the tumor and the internal target volume region. The relative displacement of the gross tumor volume between the 4D-CBCT end-expiratory phase sequence and 4D-CT was used to evaluate the registration error. Among the 20 patients (12 males, 8 females; 35-67 years old; median age, 52 years), 3 had central NSCLC and 17 had peripheral NSCLC, 8 in the upper or middle lobe and 12 in the lower lobe (maximum tumor diameter range, 18-27 mm). The internal motion range in three-dimensional space was 12.52 ± 2.65 mm, accounting for 47.8 ± 15.3% of the maximum diameter of each tumor. The errors of image-guided registration using 4D-CBCT and 3D-CBCT on the x (left-right), y (superior-inferior), z (anterior-posterior) axes, and 3D space were 0.80 ± 0.21 mm and 1.08 ± 0.25 mm, 2.02 ± 0.46 mm and 3.30 ± 0.53 mm, 0.52 ± 0.16 mm and 0.85 ± 0.24 mm, and 2.25 ± 0.44 mm and 3.59 ± 0.48 mm (all P < 0.001), respectively. Thus, 4D-CBCT is preferable to 3D-CBCT for image guidance in small pulmonary tumors because 4D-CBCT can reduce the uncertainty in the tumor location resulting from internal motion caused by respiratory movements, thereby increasing the image-guidance accuracy.
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Affiliation(s)
- Zhibo Tan
- Department of Oncology, Shenzhen Hospital of Southern Medical University, #1333 Xinhu Road, Bao'an District, Shenzhen 518110, Guangdong Province, PR China
- Department of Radiation Oncology, Sichuan Cancer Hospital, #55 Renmin Road South, Wuhou District, Chengdu 610041, Sichuan Province, PR China
| | - Chuanyao Liu
- Department of Rehabilitation, Shenzhen Hospital of Southern Medical University, #1333 Xinhu Road, Bao'an District, Shenzhen 518110, Guangdong Province, PR China
| | - Ying Zhou
- Department of Oncology and Hematology, Shenzhen Hospital of Southern Medical University, #1333 Xinhu Road, Bao'an District, Shenzhen 518110, Guangdong Province, PR China
| | - Weixi Shen
- Department of Oncology, Shenzhen Hospital of Southern Medical University, #1333 Xinhu Road, Bao'an District, Shenzhen 518110, Guangdong Province, PR China
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Usui K, Hara N, Isobe A, Inoue T, Kurokawa C, Sugimoto S, Sasai K, Ogawa K. [Impact of the Infrared Monitor Signal Pattern on Accuracy of Target Imaging in 4-dimensional Cone-beam Computed Tomography]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:469-79. [PMID: 27320150 DOI: 10.6009/jjrt.2016_jsrt_72.6.469] [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
To realize the high precision radiotherapy, localized radiation field of the moving target is very important, and visualization of a temporal location of the target can help to improve the accuracy of the target localization. However, conditions of the breathing and the patient's own motion differ from the situation of the treatment planning. Therefore, positions of the tumor are affected by these changes. In this study, we implemented a method to reconstruct target motions obtained with the 4D CBCT using the sorted projection data according to the phase and displacement of the extracorporeal infrared monitor signal, and evaluated the proposed method with a moving phantom. In this method, motion cycles and positions of the marker were sorted to reconstruct the image, and evaluated the image quality affected by changes in the cycle, phase, and positions of the marker. As a result, we realized the visualization of the moving target using the sorted projection data according to the infrared monitor signal. This method was based on the projection binning, in which the signal of the infrared monitor was surrogate of the tumor motion. Thus, further major efforts are needed to ensure the accuracy of the infrared monitor signal.
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Affiliation(s)
- Keisuke Usui
- Department of Radiation Oncology, Faculty of Medicine, Juntendo University
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Kwong Y, Mel AO, Wheeler G, Troupis JM. Four-dimensional computed tomography (4DCT): A review of the current status and applications. J Med Imaging Radiat Oncol 2015; 59:545-54. [DOI: 10.1111/1754-9485.12326] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 04/19/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Yune Kwong
- Department of Diagnostic Imaging; Monash Health; Melbourne Victoria Australia
| | - Alexandra Olimpia Mel
- Department of Biomedical Radiation Science; Faculty of Medicine; Dentistry and Nursing; Monash University; Melbourne Victoria Australia
| | - Greg Wheeler
- Department of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - John M Troupis
- Department of Diagnostic Imaging; Monash Health; Melbourne Victoria Australia
- Department of Biomedical Radiation Science; Faculty of Medicine; Dentistry and Nursing; Monash University; Melbourne Victoria Australia
- Monash Cardiovascular Research Centre; Monash University; Melbourne Victoria Australia
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Stereotactic body radiotherapy for small lung tumors in the University of Tokyo Hospital. BIOMED RESEARCH INTERNATIONAL 2014; 2014:136513. [PMID: 25110653 PMCID: PMC4109604 DOI: 10.1155/2014/136513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/03/2014] [Accepted: 06/18/2014] [Indexed: 01/08/2023]
Abstract
Our work on stereotactic body radiation therapy (SBRT) for primary and metastatic lung tumors will be described. The eligibility criteria for SBRT, our previous SBRT method, the definition of target volume, heterogeneity correction, the position adjustment using four-dimensional cone-beam computed tomography (4D CBCT) immediately before SBRT, volumetric modulated arc therapy (VMAT) method for SBRT, verifying of tumor position within internal target volume (ITV) using in-treatment 4D-CBCT during VMAT-SBRT, shortening of treatment time using flattening-filter-free (FFF) techniques, delivery of 4D dose calculation for lung-VMAT patients using in-treatment CBCT and LINAC log data with agility multileaf collimator, and SBRT method for centrally located lung tumors in our institution will be shown. In our institution, these efforts have been made with the goal of raising the local control rate and decreasing adverse effects after SBRT.
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Nakagawa K, Haga A, Sakumi A, Yamashita H, Igaki H, Shiraki T, Ohtomo K, Iwai Y, Yoda K. Impact of flattening-filter-free techniques on delivery time for lung stereotactic volumetric modulated arc therapy and image quality of concurrent kilovoltage cone-beam computed tomography: a preliminary phantom study. JOURNAL OF RADIATION RESEARCH 2014; 55:200-202. [PMID: 23979078 PMCID: PMC3885133 DOI: 10.1093/jrr/rrt105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/26/2013] [Accepted: 07/27/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Keiichi Nakagawa
- University of Tokyo Hospital, Department of Radiology, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Akihiro Haga
- University of Tokyo Hospital, Department of Radiology, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Akira Sakumi
- University of Tokyo Hospital, Department of Radiology, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hideomi Yamashita
- University of Tokyo Hospital, Department of Radiology, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Igaki
- University of Tokyo Hospital, Department of Radiology, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takashi Shiraki
- University of Tokyo Hospital, Department of Radiology, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kuni Ohtomo
- University of Tokyo Hospital, Department of Radiology, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yoshio Iwai
- Elekta KK, Research Physics, 3-9-1 Shibaura, Minato-ku, Tokyo, 108-0023, Japan
| | - Kiyoshi Yoda
- Elekta KK, Research Physics, 3-9-1 Shibaura, Minato-ku, Tokyo, 108-0023, Japan
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Nakagawa K, Haga A, Kida S, Masutani Y, Yamashita H, Takahashi W, Sakumi A, Saotome N, Shiraki T, Ohtomo K, Iwai Y, Yoda K. 4D registration and 4D verification of lung tumor position for stereotactic volumetric modulated arc therapy using respiratory-correlated cone-beam CT. JOURNAL OF RADIATION RESEARCH 2013; 54:152-6. [PMID: 22843380 PMCID: PMC3534265 DOI: 10.1093/jrr/rrs058] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
We propose a clinical workflow of stereotactic volumetric modulated arc therapy (VMAT) for a lung tumor from planning to tumor position verification using 4D planning computed tomography (CT) and 4D cone-beam CT (CBCT). A 4D CT scanner, an Anzai belt and a BodyFix were employed to obtain 10-phase respiratory-correlated CT data for a lung patient under constrained breathing conditions. A planning target volume (PTV) was defined by adding a 5-mm margin to an internal target volume created from 10 clinical target volumes, each of which was delineated on each of the 10-phase planning CT data. A single-arc VMAT plan was created with a D(95) prescription dose of 50 Gy in four fractions on the maximum exhalation phase CT images. The PTV contours were exported to a kilovoltage CBCT X-ray Volume Imaging (XVI) equipped with a linear accelerator (linac). Immediately before treatment, 10-phase 4D CBCT images were reconstructed leading to animated lung tumor imaging. Initial bone matching was performed between frame-averaged 4D planning CT and frame-averaged 4D CBCT datasets. Subsequently, the imported PTV contours and the animated moving tumor were simultaneously displayed on the XVI monitor, and a manual 4D registration was interactively performed on the monitor until the moving tumor was symmetrically positioned inside the PTV. A VMAT beam was delivered to the patient and during the delivery further 4D CBCT projection data were acquired to verify the tumor position. The entire process was repeated for each fraction. It was confirmed that the moving tumor was positioned inside the PTV during the VMAT delivery.
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Affiliation(s)
- Keiichi Nakagawa
- Department of Radiology, University of Tokyo Hospital, 7-3-1 Hongo Bunkyo-ku, Tokyo 113-8655, Japan.
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