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Shiraishi S, Yamanaka M, Shiba S, Tokuuye K. Assessing alimentary tract radiation in liver cancer treatment with proton beam therapy: a PET/CT imaging study. Jpn J Clin Oncol 2024:hyae085. [PMID: 38943456 DOI: 10.1093/jjco/hyae085] [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: 03/20/2024] [Accepted: 06/13/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Proton beams deposit energy along their path, abruptly stopping and generating various radioactive particles, including positrons, along their trajectory. In comparison with traditional proton beam therapy, scanning proton beam therapy is effective in delivering proton beams to irregularly shaped tumors, reducing excessive radiation exposure to the alimentary tract during the treatment of liver cancer. METHODS In this study, we utilized positron emission tomography/computed tomography (PET/CT) imaging to assess the total amount of radiation to the alimentary tract during liver cancer treatment with proton beam therapy, involving the administration of complex irradiation in 13 patients. RESULTS This approach resulted in the prevention of excess radiation. The planned radiation restraint doses for the colon exhibited a significant correlation with the PET values of the colon (correlation coefficient 0.8384, P = .0003). Likewise, the scheduled radiation restraint doses for the gastroduodenum were correlated with the PET values of the gastroduodenum (correlation coefficient 0.5397, P = .0569). CONCLUSIONS PET/CT conducted after proton beam therapy is useful for evaluating excess radiation in the alimentary tract. Proton beam therapy in liver cancer, assessed via PET/CT, effectively reduced alimentary tract radiation, which is vital for optimizing treatments and preventing excess exposure.
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Affiliation(s)
- Sachika Shiraishi
- Department of Radiation Oncology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-City, Kanagawa 247-8533, Japan
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Masashi Yamanaka
- Department of Medical Physics, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-City, Kanagawa 247-8533, Japan
| | - Shintaro Shiba
- Department of Radiation Oncology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-City, Kanagawa 247-8533, Japan
| | - Koichi Tokuuye
- Department of Radiation Oncology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-City, Kanagawa 247-8533, Japan
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
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Fichtl A, Sheikhani A, Wagner M, Kleger A, Müller M, Sturm N, Walter B, Franz AM. Implementing an electromagnetic tracking navigation system improves the precision of endoscopic transgastric necrosectomy in an ex vivo model. Sci Rep 2024; 14:10055. [PMID: 38698058 PMCID: PMC11066121 DOI: 10.1038/s41598-024-60647-w] [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: 06/29/2023] [Accepted: 04/25/2024] [Indexed: 05/05/2024] Open
Abstract
Endoscopic transgastric necrosectomy is crucial in the management of complications resulting from necrotizing pancreatitis. However, both real-time and visual-spatial information is lacking during the procedure, thereby jeopardizing a precise positioning of the endoscope. We conducted a proof-of-concept study with the aim of overcoming these technical difficulties. For this purpose, a three-dimensional (3D) phantom of a stomach and pancreatic necroses was 3D-printed based on spatial information from individual patient CT scans and subsequently integrated into a silicone torso. An electromagnetic (EM) sensor was adjusted inside the endoscope´s working channel. A software interface enabled real time visualization. The accuracy of this novel assistant system was tested ex vivo by four experienced interventional endoscopists who were supposed to reach seven targets inside the phantom in six different experimental runs of simulated endoscopic transgastric necrosectomy. Supported by endoscopic camera view combined with real-time 3D visualization, all endoscopists reached the targets with a targeting error ranging between 2.6 and 6.5 mm in a maximum of eight minutes. In summary, the EM tracking system might increase efficacy and safety of endoscopic transgastric necrosectomy at the experimental level by enhancing visualization. Yet, a broader feasibility study and further technical improvements are mandatory before aiming at implementation into clinical setting.
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Affiliation(s)
- Anna Fichtl
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
- Endoscopic Research Unit, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Alaan Sheikhani
- Institute for Medical Engineering and Mechatronics, University of Applied Sciences Ulm, Albert-Einstein-Allee 53-55, 89081, Ulm, Germany
| | - Martin Wagner
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Alexander Kleger
- Institute of Molecular Oncology and Stem Cell Biology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
- Division of Interdisciplinary Pancreatology, Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Martin Müller
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Niklas Sturm
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
- Endoscopic Research Unit, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Benjamin Walter
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
- Endoscopic Research Unit, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Alfred Michael Franz
- Institute for Medical Engineering and Mechatronics, University of Applied Sciences Ulm, Albert-Einstein-Allee 53-55, 89081, Ulm, Germany
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
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Steybe D, Voss PJ, Metzger MC, Schmelzeisen R, Poxleitner P. Virtual tumor mapping and margin control with 3-D planning and navigation. Innov Surg Sci 2024; 9:17-24. [PMID: 38826628 PMCID: PMC11138405 DOI: 10.1515/iss-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/20/2024] [Indexed: 06/04/2024] Open
Abstract
Computer technology-based treatment approaches like intraoperative navigation and intensity-modulated radiation therapy have become important components of state of the art head and neck cancer treatment. Multidirectional exchange of virtual three-dimensional patient data via an interdisciplinary platform allows all medical specialists involved in the patients treatment to take full advantage of these technologies. This review article gives an overview of current technologies and future directions regarding treatment approaches that are based on a virtual, three-dimensional patient specific dataset: storage and exchange of spatial information acquired via intraoperative navigation allow for a highly precise frozen section procedure. In the postoperative setting, virtual reconstruction of the tumor resection surface provides the basis for improved radiation therapy planning and virtual reconstruction of the tumor with integration of molecular findings creates a valuable tool for postoperative treatment and follow-up. These refinements of established treatment components and novel approaches have the potential to make a major contribution to improving the outcome in head and neck cancer patients.
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Affiliation(s)
- David Steybe
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Pit J. Voss
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Marc C. Metzger
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme for Clinician Scientists, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Nemoto H, Saito M, Suzuki T, Suzuki H, Sano N, Mochizuki Z, Mochizuki K, Ueda K, Komiyama T, Marino K, Aoki S, Oguri M, Takahashi H, Onishi H. Evaluation of computed tomography metal artifact and CyberKnife fiducial recognition for novel size fiducial markers. J Appl Clin Med Phys 2023; 24:e14142. [PMID: 37672211 PMCID: PMC10691645 DOI: 10.1002/acm2.14142] [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: 12/06/2022] [Revised: 06/28/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE This study aimed to compare fiducial markers used in CyberKnife treatment in terms of metal artifact intensity observed in CT images and fiducial recognition in the CyberKnife system affected by patient body thickness and type of marker. METHODS Five markers, ACCULOC 0.9 mm × 3 mm, Ball type Gold Anchor (GA) 0.28 mm × 10 mm, 0.28 mm × 20 mm, and novel size GA 0.4 mm × 10 mm, 0.4 mm × 20 mm were evaluated. To evaluate metal artifacts of CT images, two types of CT images of water-equivalent gels with each marker were acquired using Aquilion LB CT scanner, one applied SEMAR (SEMAR-on) and the other did not apply this technique (SEMAR-off). The evaluation metric of artifact intensity (MSD ) which represents a variation of CT values were compared for each marker. Next, 5, 15, and 20 cm thickness of Tough Water (TW) was placed on the gel under the condition of overlapping the vertebral phantom in the Target Locating System, and the live image of each marker was acquired to compare fiducial recognition. RESULTS The mean MSD of SEMAR-off was 78.80, 74.50, 97.25, 83.29, and 149.64 HU for ACCULOC, GA0.28 mm × 10 mm, 20 mm, and 0.40 mm × 10 mm, 20 mm, respectively. In the same manner, that of SEMAR-on was 23.52, 20.26, 26.76, 24.89, and 33.96 HU, respectively. Fiducial recognition decreased in the order of 5, 15, and 20 cm thickness, and GA 0.4 × 20 mm showed the best recognition at thickness of 20 cm TW. CONCLUSIONS We demonstrated the potential to reduce metal artifacts in the CT image to the same level for all the markers we evaluated by applying SEMAR. Additionally, the fiducial recognition of each marker may vary depending on the thickness of the patient's body. Particularly, we showed that GA 0.40 × 20 mm may have more optimal recognition for CyberKnife treatment in cases of high bodily thickness in comparison to the other markers.
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Affiliation(s)
- Hikaru Nemoto
- Department of Advanced Biomedical ImagingUniversity of YamanashiYamanashiJapan
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Masahide Saito
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Hidekazu Suzuki
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Naoki Sano
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Koji Mochizuki
- Kasugai CyberKnife Rehabilitation HospitalYamanashiJapan
| | - Koji Ueda
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Kan Marino
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Shinichi Aoki
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Mitsuhiko Oguri
- Department of RadiologyShizuoka General HospitalShizuokaJapan
| | | | - Hiroshi Onishi
- Department of RadiologyUniversity of YamanashiYamanashiJapan
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Brown K, Ghita M, Prise KM, Butterworth KT. Feasibility and guidelines for the use of an injectable fiducial marker (BioXmark ®) to improve target delineation in preclinical radiotherapy studies using mouse models. F1000Res 2023; 12:526. [PMID: 38799243 PMCID: PMC11116939 DOI: 10.12688/f1000research.130883.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Preclinical models of radiotherapy (RT) response are vital for the continued success and evolution of RT in the treatment of cancer. The irradiation of tissues in mouse models necessitates high levels of precision and accuracy to recapitulate clinical exposures and limit adverse effects on animal welfare. This requirement has been met by technological advances in preclinical RT platforms established over the past decade. Small animal RT systems use onboard computed tomography (CT) imaging to delineate target volumes and have significantly refined radiobiology experiments with major 3Rs impacts. However, the CT imaging is limited by the differential attenuation of tissues resulting in poor contrast in soft tissues. Clinically, radio-opaque fiducial markers (FMs) are used to establish anatomical reference points during treatment planning to ensure accuracy beam targeting, this approach is yet to translate back preclinical models. METHODS We report on the use of a novel liquid FM BioXmark ® developed by Nanovi A/S (Kongens Lyngby, Denmark) that can be used to improve the visualisation of soft tissue targets during beam targeting and minimise dose to surrounding organs at risk. We present descriptive protocols and methods for the use of BioXmark ® in experimental male and female C57BL/6J mouse models. RESULTS These guidelines outline the optimum needle size for uptake (18-gauge) and injection (25- or 26-gauge) of BioXmark ® for use in mouse models along with recommended injection volumes (10-20 µl) for visualisation on preclinical cone beam CT (CBCT) scans. Injection techniques include subcutaneous, intraperitoneal, intra-tumoral and prostate injections. CONCLUSIONS The use of BioXmark ® can help to standardise targeting methods, improve alignment in preclinical image-guided RT and significantly improve the welfare of experimental animals with the reduction of normal tissue exposure to RT.
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Affiliation(s)
- Kathryn Brown
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, BT9 7AE, UK
| | - Mihaela Ghita
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, BT9 7AE, UK
| | - Kevin M Prise
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, BT9 7AE, UK
| | - Karl T Butterworth
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, BT9 7AE, UK
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Mäkelä P, Wright C, Anttinen M, Boström PJ, Blanco Sequeiros R. Safety and efficacy of MRI-guided transurethral ultrasound ablation for radiorecurrent prostate cancer in the presence of gold fiducial markers. Acta Radiol 2023; 64:1228-1237. [PMID: 35748746 DOI: 10.1177/02841851221108292] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Safety and efficacy of ultrasound prostate ablation for radiorecurrent prostate cancer (PCa) in the presence of gold fiducial markers has not been previously reported. PURPOSE To evaluate safety, functional, and early-stage oncological outcomes for patients with gold fiducial markers undergoing salvage magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (sTULSA) for radiorecurrent PCa. MATERIAL AND METHODS Data were acquired from an ethics-approved, single-center phase-1 study. Eight patients with 18 total gold fiducial markers inside the planned treatment volume were identified. MRI controls were performed at three and 12 months, followed by PSMA-PET-CT imaging and biopsies at 12 months. A control cohort of 13 patients who underwent sTULSA without markers were also identified for safety profile comparison. Adverse events were reported using the Clavien-Dindo classification, and questionnaires including EPIC-26, IPSS, and IIEF-5 were collected. RESULTS Of 18 markers, 2 (11%) were directly responsible for poor ultrasound penetration. However, there were no local recurrences at 12 months. PSA, prostate volume, and non-perfused volume all decreased over time. At 12 months, 11/18 (61%) of fiducial markers had disappeared via sloughing. The adverse event profile was similar between both patient cohorts, and when controlled for ablation type, no statistical difference in functional outcomes between the two cohorts was observed. CONCLUSION Patients with radiorecurrent PCa with intraprostatic gold fiducial markers can be successfully treated with TULSA. The early-stage efficacy of sTULSA for patients with intraprostatic gold markers is encouraging and the safety profile is unaffected by marker presence.
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Affiliation(s)
- Pietari Mäkelä
- Department of Diagnostic Radiology, 60652Turku University Hospital, Turku, Finland
| | - Cameron Wright
- Department of Diagnostic Radiology, 60652Turku University Hospital, Turku, Finland
- Department of Urology, 60652Turku University Hospital, Turku, Finland
| | - Mikael Anttinen
- Department of Urology, 60652Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, 60652Turku University Hospital, Turku, Finland
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Moreau M, Richards G, Yasmin-Karim S, Narang A, Deville C, Ngwa W. A liquid immunogenic fiducial eluter for image-guided radiotherapy. Front Oncol 2022; 12:1020088. [PMID: 36620560 PMCID: PMC9812550 DOI: 10.3389/fonc.2022.1020088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Fiducials are routinely used to provide image-guidance during radiotherapy. Here, a new nanoparticle-based liquid immunogenic fiducial is investigated for its potential to provide image-guidance, while also enhancing treatment outcomes. Methods This fiducial, liquid immunogenic fiducial eluter (LIFE) biomaterial, is formulated with natural biodegradable polymers, chitosan and sodium alginate with radio-sensitizing nanoparticles, and immunoadjuvant like anti-CD40 monoclonal antibody. Once administered intra-tumorally, this liquid smart radiotherapy biomaterial congeals within the calcium rich tumor microenvironment. The potential use of LIFE biomaterial for providing image guidance in magnetic resonance imaging (MRI) and computed tomography (CT) was investigated over different time period in a pre-clinical tumored mouse model. Results Results showed that the LIFE biomaterial can provide both MRI contrast and CT imaging contrast over 3-weeks, with gradual decrease of the contrast over time, as the LIFE biomaterial biodegrades. Results also showed the LIFE biomaterial significantly slowed tumor growth and prolonged mice survival (p < 0.0001) over time. Discussion The results highlight the potential use of the LIFE biomaterial as a multi-functional smart radiotherapy biomaterial that could be developed and optimized for hypo-fractionated radiotherapy applications and combining radiotherapy with immunoadjuvants.
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Affiliation(s)
- Michele Moreau
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States,Department of Radiation Oncology and Molecular Radiation Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, United States,Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States,*Correspondence: Michele Moreau, ; Wilfred Ngwa,
| | - Geraud Richards
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Sayeda Yasmin-Karim
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Amol Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Curtiland Deville
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Wilfred Ngwa
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States,Department of Radiation Oncology and Molecular Radiation Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, United States,Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States,*Correspondence: Michele Moreau, ; Wilfred Ngwa,
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Stephens S, Ingels N, Wenk J, Jensen M. Alumina as a Computed Tomography Soft Material and Tissue Fiducial Marker. EXPERIMENTAL MECHANICS 2022; 62:879-884. [PMID: 36034684 PMCID: PMC9400951 DOI: 10.1007/s11340-022-00825-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/13/2022] [Indexed: 06/03/2023]
Abstract
Background The use of 3D imaging is becoming increasingly common, so too is the use of fiducial markers to identify/track regions of interest and assess material deformation. While many different materials have been used as fiducials, they are often used in isolation, with little comparison to one another. Objective In the current study, we aim to directly compare different Computed Tomography (CT and μCT) fiducial materials, both metallic and nonmetallic. Methods μCT imaging was performed on a soft-tissue structure, in this case heart valve tissue, with various markers attached. Additionally, we evaluated the same markers with DiceCT stained tissue in a fluid medium. Eight marker materials were tested in all. Results All of the metallic markers generated significant artifacts and were found unsuitable for soft-tissue μCT imaging, whereas alumina markers were found to perform the best, with excellent contrast and consistency. Conclusions These findings support the further use of alumina as fiducial markers for soft material and tissue studies that utilize CT and μCT imaging.
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Affiliation(s)
- S.E. Stephens
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, Arkansas, United States of America
| | - N.B. Ingels
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, Arkansas, United States of America
| | - J.F. Wenk
- Department of Mechanical Engineering, University of Kentucky, Lexington, Kentucky, United States of America
| | - M.O. Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, Arkansas, United States of America
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Reidel CA, Horst F, Schuy C, Jäkel O, Ecker S, Henkner K, Brons S, Durante M, Weber U. Experimental Comparison of Fiducial Markers Used in Proton Therapy: Study of Different Imaging Modalities and Proton Fluence Perturbations Measured With CMOS Pixel Sensors. Front Oncol 2022; 12:830080. [PMID: 35402273 PMCID: PMC8990863 DOI: 10.3389/fonc.2022.830080] [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: 12/06/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Fiducial markers are used for image guidance to verify the correct positioning of the target for the case of tumors that can suffer interfractional motion during proton therapy. The markers should be visible on daily imaging, but at the same time, they should produce minimal streak artifacts in the CT scans for treatment planning and induce only slight dose perturbations during particle therapy. In this work, these three criteria were experimentally investigated at the Heidelberg Ion Beam Therapy Center. Several small fiducial markers with different geometries and materials (gold, platinum, and carbon-coated ZrO2) were evaluated. The streak artifacts on treatment planning CT were measured with and without iMAR correction, showing significantly smaller artifacts from markers lighter than 6 mg and a clear improvement with iMAR correction. Daily imaging as X-ray projections and in-room mobile CT were also performed. Markers heavier than 6 mg showed a better contrast in the X-ray projections, whereas on the images from the in-room mobile CT, all markers were clearly visible. In the other part of this work, fluence perturbations of proton beams were measured for the same markers by using a tracker system of several high spatial resolution CMOS pixel sensors. The measurements were performed for single-energy beams, as well as for a spread-out Bragg peak. Three-dimensional fluence distributions were computed after reconstructing all particle trajectories. These measurements clearly showed that the ZrO2 markers and the low-mass gold/platinum markers (0.35mm diameter) induce perturbations being 2–3 times lower than the heavier gold or platinum markers of 0.5mm diameter. Monte Carlo simulations, using the FLUKA code, were used to compute dose distributions and showed good agreement with the experimental data after adjusting the phase space of the simulated proton beam compared to the experimental beam.
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Affiliation(s)
- Claire-Anne Reidel
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - Felix Horst
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - Christoph Schuy
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- *Correspondence: Christoph Schuy,
| | - Oliver Jäkel
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany
| | - Swantje Ecker
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany
| | - Katrin Henkner
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany
| | - Stephan Brons
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany
| | - Marco Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- Institut für Physik Kondensierter Materie, Technische Universität Darmstadt, Darmstadt, Germany
| | - Uli Weber
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
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Li Y, Li X, Yang J, Wang S, Tang M, Xia J, Gao Y. Flourish of Proton and Carbon Ion Radiotherapy in China. Front Oncol 2022; 12:819905. [PMID: 35237518 PMCID: PMC8882681 DOI: 10.3389/fonc.2022.819905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Proton and heavy ion therapy offer superior relative biological effectiveness (RBE) in the treatment of deep-seated tumors compared with conventional photon radiotherapy due to its Bragg-peak feature of energy deposition in organs. Many proton and carbon ion therapy centers are active all over the world. At present, five particle radiotherapy institutes have been built and are receiving patient in China, mainly including Wanjie Proton Therapy Center (WPTC), Shanghai Proton Heavy Ion Center (SPHIC), Heavy Ion Cancer Treatment Center (HIMM), Chang Gung Memorial Hospital (CGMH), and Ruijin Hospital affiliated with Jiao Tong University. Many cancer patients have benefited from ion therapy, showing unique advantages over surgery and chemotherapy. By the end of 2020, nearly 8,000 patients had been treated with proton, carbon ion or carbon ion combined with proton therapy. So far, there is no systemic review for proton and carbon ion therapy facility and clinical outcome in China. We reviewed the development of proton and heavy ion therapy, as well as providing the representative clinical data and future directions for particle therapy in China. It has important guiding significance for the design and construction of new particle therapy center and patients’ choice of treatment equipment.
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Affiliation(s)
- Yue Li
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- *Correspondence: Yue Li,
| | - Xiaoman Li
- Department of Radiation Medicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Jiancheng Yang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
| | - Sicheng Wang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
| | - Meitang Tang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
| | - Jiawen Xia
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- Huizhou Research Center of Ion Science, Chinese Academy of Sciences, Huizhou, China
| | - Yunzhe Gao
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, China
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11
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Beaton L, Daly M, Tregidgo HF, Grimes H, Moinuddin S, Stacey C, Znati S, Hague J, Bascal ZA, Wilde PE, Cooper S, Bandula S, Lewis AL, Clarkson MJ, Sharma RA. Radiopaque drug-eluting embolisation beads as fiducial markers for stereotactic liver radiotherapy. Br J Radiol 2021; 95:20210594. [PMID: 34762499 PMCID: PMC8822567 DOI: 10.1259/bjr.20210594] [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] [Indexed: 11/10/2022] Open
Abstract
Objective: To determine the feasibility of using radiopaque (RO) beads as direct tumour surrogates for image-guided radiotherapy (IGRT) in patients with liver tumours after transarterial chemoembolisation (TACE). Methods: A novel vandetanib-eluting RO bead was delivered via TACE as part of a first-in-human clinical trial in patients with either hepatocellular carcinoma or liver metastases from colorectal cancer. Following TACE, patients underwent simulated radiotherapy imaging with four-dimensional computed tomography (4D-CT) and cone-beam CT (CBCT) imaging. RO beads were contoured using automated thresholding, and feasibility of matching between the simulated radiotherapy planning dataset (AVE-IP image from 4D data) and CBCT scans assessed. Additional kV, MV, helical CT and CBCT images of RO beads were obtained using an in-house phantom. Stability of RO bead position was assessed by comparing 4D-CT imaging to CT scans taken 6–20 days following TACE. Results: Eight patients were treated and 4D-CT and CBCT images acquired. RO beads were visible on 4D-CT and CBCT images in all cases and matching successfully performed. Differences in centre of mass of RO beads between CBCT and simulated radiotherapy planning scans (AVE-IP dataset) were 2.0 mm mediolaterally, 1.7 mm anteroposteriorally and 3.5 mm craniocaudally. RO beads in the phantom were visible on all imaging modalities assessed. RO bead position remained stable up to 29 days post TACE. Conclusion: RO beads are visible on IGRT imaging modalities, showing minimal artefact. They can be used for on-set matching with CBCT and remain stable over time. Advances in knowledge: The role of RO beads as fiducial markers for stereotactic liver radiotherapy is feasible and warrants further exploration as a combination therapy approach.
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Affiliation(s)
- Laura Beaton
- University College London Cancer Institute, University College London, London, United Kingdom
| | - Mairead Daly
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Henry Fj Tregidgo
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Helen Grimes
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Syed Moinuddin
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Chris Stacey
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sami Znati
- University College London Cancer Institute, University College London, London, United Kingdom
| | - Julian Hague
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Zainab A Bascal
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Paul E Wilde
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Sarah Cooper
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Steven Bandula
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Andrew L Lewis
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, United Kingdom
| | - Matthew J Clarkson
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ricky A Sharma
- University College London Cancer Institute, University College London, London, United Kingdom.,National Institute for Health Research University College London Hospitals Biomedical Centre, University College London Cancer Institute, London, United Kingdom
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12
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Yoo GS, Yu JI, Park HC. Current role of proton beam therapy in patients with hepatocellular carcinoma. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2021. [DOI: 10.18528/ijgii210043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Affiliation(s)
- Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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13
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Target motion management in breast cancer radiation therapy. Radiol Oncol 2021; 55:393-408. [PMID: 34626533 PMCID: PMC8647788 DOI: 10.2478/raon-2021-0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/04/2021] [Indexed: 12/25/2022] Open
Abstract
Background Over the last two decades, breast cancer remains the main cause of cancer deaths in women. To treat this type of cancer, radiation therapy (RT) has proved to be efficient. RT for breast cancer is, however, challenged by intrafractional motion caused by respiration. The problem is more severe for the left-sided breast cancer due to the proximity to the heart as an organ-at-risk. While particle therapy results in superior dose characteristics than conventional RT, due to the physics of particle interactions in the body, particle therapy is more sensitive to target motion. Conclusions This review highlights current and emerging strategies for the management of intrafractional target motion in breast cancer treatment with an emphasis on particle therapy, as a modern RT technique. There are major challenges associated with transferring real-time motion monitoring technologies from photon to particles beams. Surface imaging would be the dominant imaging modality for real-time intrafractional motion monitoring for breast cancer. The magnetic resonance imaging (MRI) guidance and ultra high dose rate (FLASH)-RT seem to be state-of-the-art approaches to deal with 4D RT for breast cancer.
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14
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Xu TT, Pulido JS, Parney IF, Ida CM, Dalvin LA, Olsen TW. Carbon Fiducial Markers for Tumor Localization in Stereotactic Irradiation of Uveal Melanoma. Ocul Oncol Pathol 2021; 7:368-375. [PMID: 34722494 PMCID: PMC8531828 DOI: 10.1159/000518742] [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: 05/01/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of this study was to demonstrate the role of carbon fiducial markers (fiducials) for guiding radiotherapy in the management of uveal melanoma (UM). METHODS This is a retrospective interventional case series at a single-center ocular oncology practice. The medical records were reviewed retrospectively for all patients with UM treated with stereotactic radiosurgery using episcleral fiducials. We report our short-term experience with surgical placement of fiducials, UM localization, treatment outcomes, and optimization approaches. RESULTS We evaluated 11 cases of UM (mean age: 65 years; 64% female). The placed fiducials were numbered from 2 to 4, each secured to the sclera with a surgical microscope or surgical loupes and either 5-0 or 8-0 nylon sutures at 50% scleral depth and 3 mm beyond the tumor margin. Over a median follow-up of 11 months (range: 4.2-43.2 months), no recurrences of intraocular UM were observed. One case of enucleation after stereotactic radiosurgery developed because of radiation-related surface irritation, ocular dryness, and secondary keratopathy. Two patients (18%) with 5-0 nylon sutures required fiducial removal because of suture exposure, successfully accomplished in an outpatient setting. CONCLUSIONS Fiducials represent a viable alternative to tantalum rings for guiding stereotactic radiotherapy to manage UM and provide additional definition of the tumor border with linear orientation that helps optimize targeted radiation delivery. Fiducial placement with a 3-mm margin from the visible tumor border should not result in clinically important radiation dose attenuation at the tumor margins. Anteriorly placed fiducials may cause discomfort, yet they are easily removed in the outpatient setting.
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Affiliation(s)
- Timothy T. Xu
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jose S. Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian F. Parney
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cristiane M. Ida
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lauren A. Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy W. Olsen
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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15
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Visser S, den Otter LA, Ribeiro CO, Korevaar EW, Both S, Langendijk JA, Muijs CT, Sijtsema NM, Knopf A. Diaphragm-Based Position Verification to Improve Daily Target Dose Coverage in Proton and Photon Radiation Therapy Treatment of Distal Esophageal Cancer. Int J Radiat Oncol Biol Phys 2021; 112:463-474. [PMID: 34530091 DOI: 10.1016/j.ijrobp.2021.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 08/21/2021] [Accepted: 09/06/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE In modern conformal radiation therapy of distal esophageal cancer, target coverage can be affected by variations in the diaphragm position. We investigated if daily position verification (PV) extended by a diaphragm position correction would optimize target dose coverage for esophageal cancer treatment. METHODS AND MATERIALS For 15 esophageal cancer patients, intensity modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) plans were computed. Displacements of the target volume were correlated with diaphragm displacements using repeated 4-dimensional computed tomography images to determine the correction needed to account for diaphragm variations. Afterwards, target coverage was evaluated for 3 PV approaches based on: (1) bony anatomy (PV_B), (2) bony anatomy corrected for the diaphragm position (PV_BD) and (3) target volume (PV_T). RESULTS The cranial-caudal mean target displacement was congruent with almost half of the diaphragm displacement (y = 0.459x), which was used for the diaphragm correction in PV_BD. Target dose coverage using PV_B was adequate for most patients with diaphragm displacements up till 10 mm (≥94% of the dose in 98% of the volume [D98%]). For larger displacements, the target coverage was better maintained by PV_T and PV_BD. Overall, PV_BD accounted best for target displacements, especially in combination with tissue density variations (D98%: IMPT 94% ± 5%, VMAT 96% ± 5%). Diaphragm displacements of more than 10 mm were observed in 22% of the cases. CONCLUSIONS PV_B was sufficient to achieve adequate target dose coverage in case of small deviations in diaphragm position. However, large deviations of the diaphragm were best mitigated by PV_BD. To detect the cases where target dose coverage could be compromised due to diaphragm position variations, we recommend monitoring of the diaphragm position before treatment through online imaging.
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Affiliation(s)
- Sabine Visser
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Lydia A den Otter
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cássia O Ribeiro
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik W Korevaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan Both
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antje Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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16
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Tsubouchi T, Hamatani N, Takashina M, Wakisaka Y, Ogawa A, Yagi M, Terasawa A, Shimazaki K, Chatani M, Mizoe J, Kanai T. Carbon ion radiotherapy using fiducial markers for prostate cancer in Osaka HIMAK: Treatment planning. J Appl Clin Med Phys 2021; 22:242-251. [PMID: 34339590 PMCID: PMC8425940 DOI: 10.1002/acm2.13376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/06/2021] [Accepted: 07/18/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Carbon ion radiotherapy for prostate cancer was performed using two fine needle Gold Anchor (GA) markers for patient position verification in Osaka Heavy Ion Medical Accelerator in Kansai (Osaka HIMAK). The present study examined treatment plans for prostate cases using beam-specific planning target volume (bsPTV) based on the effect of the markers on dose distribution and analysis of target movements. MATERIALS AND METHODS Gafchromic EBT3 film was used to measure dose perturbations caused by markers. First, the relationships between the irradiated film density and absolute dose with different linear energy transfer distributions within a spread-out Bragg peak (SOBP) were confirmed. Then, to derive the effect of markers, two types of markers, including GA, were placed at the proximal, center, and distal depths within the same SOBP, and dose distributions behind the markers were measured using the films. The amount of internal motion of prostate was derived from irradiation results and analyzed to determine the margins of the bsPTV. RESULTS The linearity of the film densities against absolute doses was constant within the SOBP and the amount of dose perturbations caused by the markers was quantitatively estimated from the film densities. The dose perturbation close behind the markers was smallest (<10% among depths within the SOBP regardless of types of markers) and increased with depth. The effect of two types of GAs on dose distributions was small and could be ignored in the treatment planning. Based on the analysis results of internal motions of prostate, required margins of the bsPTV were found to be 8, 7, and 7 mm in left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions, respectively. CONCLUSION We evaluated the dose reductions caused by markers and determined the margins of the bsPTV, which was applied to the treatment using fiducial markers, using the analysis results of prostate movements.
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Affiliation(s)
| | | | | | | | | | - Masashi Yagi
- Department of Carbon Ion RadiotherapyOsaka University Graduate School of MedicineSuita CityOsakaJapan
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Kazemimoghadam M, Chi W, Rahimi A, Kim N, Alluri P, Nwachukwu C, Lu W, Gu X. Saliency-guided deep learning network for automatic tumor bed volume delineation in post-operative breast irradiation. Phys Med Biol 2021; 66:10.1088/1361-6560/ac176d. [PMID: 34298539 PMCID: PMC8639319 DOI: 10.1088/1361-6560/ac176d] [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: 04/22/2021] [Accepted: 07/23/2021] [Indexed: 11/12/2022]
Abstract
Efficient, reliable and reproducible target volume delineation is a key step in the effective planning of breast radiotherapy. However, post-operative breast target delineation is challenging as the contrast between the tumor bed volume (TBV) and normal breast tissue is relatively low in CT images. In this study, we propose to mimic the marker-guidance procedure in manual target delineation. We developed a saliency-based deep learning segmentation (SDL-Seg) algorithm for accurate TBV segmentation in post-operative breast irradiation. The SDL-Seg algorithm incorporates saliency information in the form of markers' location cues into a U-Net model. The design forces the model to encode the location-related features, which underscores regions with high saliency levels and suppresses low saliency regions. The saliency maps were generated by identifying markers on CT images. Markers' location were then converted to probability maps using a distance transformation coupled with a Gaussian filter. Subsequently, the CT images and the corresponding saliency maps formed a multi-channel input for the SDL-Seg network. Our in-house dataset was comprised of 145 prone CT images from 29 post-operative breast cancer patients, who received 5-fraction partial breast irradiation (PBI) regimen on GammaPod. The 29 patients were randomly split into training (19), validation (5) and test (5) sets. The performance of the proposed method was compared against basic U-Net. Our model achieved mean (standard deviation) of 76.4(±2.7) %, 6.76(±1.83) mm, and 1.9(±0.66) mm for Dice similarity coefficient, 95 percentile Hausdorff distance, and average symmetric surface distance respectively on the test set with computation time of below 11 seconds per one CT volume. SDL-Seg showed superior performance relative to basic U-Net for all the evaluation metrics while preserving low computation cost. The findings demonstrate that SDL-Seg is a promising approach for improving the efficiency and accuracy of the on-line treatment planning procedure of PBI, such as GammaPod based PBI.
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Affiliation(s)
- Mahdieh Kazemimoghadam
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Weicheng Chi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
- School of Software Engineering, South China University of Technology, Guangzhou, Guangdong 510006, People's Republic of China
| | - Asal Rahimi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Nathan Kim
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Prasanna Alluri
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Chika Nwachukwu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | | | - Xuejun Gu
- Stanford University, Palo Alto, CA, United States of America
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Comparison of technical success and safety of transbronchial versus percutaneous CT-guided fiducial placement for SBRT of lung tumors. J Med Imaging Radiat Sci 2021; 52:409-416. [PMID: 34229986 DOI: 10.1016/j.jmir.2021.06.004] [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: 03/11/2021] [Revised: 05/29/2021] [Accepted: 06/09/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the technical success and safety of transbronchial (bronchoscopic) fiducial placement compared to percutaneous CT-guided fiducial placement for stereotactic body radiotherapy (SBRT) of lung tumors. MATERIALS AND METHODS This IRB-approved, HIPAA-compliant retrospective study was performed at a single tertiary institution. Consecutive patients undergoing lung fiducial placement for purposes of guiding SBRT (CyberKnife®, Accuray, Inc.) between September 2005 to January 2013 were included in the study. Fiducial seeds were placed percutaneously with CT guidance or transbronchially with bronchoscopic guidance. We compared procedure-related complications (pneumothorax, chest tube placement), technical success (defined as implantation enabling adequate treatment planning with CT simulation) and migration rate. The need for repeat procedures and their mode was noted. Statistical analysis was performed using Fisher exact and Chi square probability tests. RESULTS Two hundred and forty-four patients with lung tumors and 272 fiducial seed placements were included in the study. Two hundred and twenty-one of the 272 (81.2%) fiducial markers were placed percutaneously and 51/272 (18.8%) were placed transbronchially. Pneumothorax was seen in 73/221 (33%) of percutaneously-placed fiducials and in 4/51 (7.8%) of transbronchial placements (p<0.001). No significant difference was seen in the rate of chest tube placement between the two groups: 20/221 (9%) of percutaneously placed fiducials and 2/51 (3.9%) of transbronchially placed fiducials (p=0.39). Fifteen of the 51 (29%) of fiducial placements with transbronchial approach were unsuccessful, as discovered at radiotherapy planning session, and required a repeat procedure. Nine of the 15 (60%) of repeat procedures were performed percutaneously, 5/15 (33%) were placed during repeat bronchoscopy, and 1/15 (7%) was placed at transesophageal endoscopic ultrasound. No repeat fiducial placements were required for patients who had the fiducials placed percutaneously (p<0.001), with a technical success rate of 100%. CONCLUSION Transbronchial fiducial marker placement has a significantly higher rate of failed seed placements requiring repeat procedures in comparison to percutaneous placement. Complication rate of pneumothorax requiring chest drain placement is similar between the two approaches.
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19
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Steybe D, Russe MF, Ludwig U, Sprave T, Vach K, Semper-Hogg W, Schmelzeisen R, Voss PJ, Poxleitner P. Intraoperative marking of the tumour resection surface for improved radiation therapy planning in head and neck cancer: preclinical evaluation of a novel liquid fiducial marker. Dentomaxillofac Radiol 2021; 50:20200290. [PMID: 32915672 DOI: 10.1259/dmfr.20200290] [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] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate a novel liquid fiducial marker for intraoperative marking of the tumour resection surface in oral cancer patients to facilitate precise postoperative delineation of the interface between the tumour resection border and reconstructed tissue for intensity-modulated radiation therapy. METHODS A total of 200 markers were created by injecting the volumes of 10 µl, 20 µl, 30 µl, 40 µl and 50 µl of a liquid marker composed of sucrose acetoisobutyrate (SAIB) and iodinated sucrose acetoisobutyrate (x-SAIB) into the soft tissue of porcine mandible segments. Visibility of the resulting markers was quantified by threshold-based segmentation of the marker volume in CT- and CBCT imaging and by a comparison of signal intensities in MRI. RESULTS Even the lowest volume of SAIB-/x-SAIB investigated (10 µl) resulted in a higher visibility (CTSoft tissue: 88.18 ± 13.23 µl; CTBone: 49.55 ± 7.62 µl; CBCT: 54.65 ± 12.58 µl) than observed with the incorporation of titanium ligature clips (CTSoft tissue: 50.15 ± 7.50 mm3; CTBone: 23.90 ± 3.39 mm3; CBCT: 33.80 ± 9.20 mm3). Markers created by the injection of 10 µl and 20 µl could reliably be delineated from markers created by the injection of higher volumes. CONCLUSION SAIB/x-SAIB, which has recently become available as a Conformité Européenne (CE)-marked fiducial marker, provides an option for fast and reliable production of markers with excellent visibility in imaging modalities used in oral cancer radiation therapy (RT) planning routine.
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Affiliation(s)
- David Steybe
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Frederik Russe
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ute Ludwig
- Medical Physics, Department of Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Wiebke Semper-Hogg
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Pit Jacob Voss
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Berta-Ottenstein-Programme for Clinician Scientists, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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20
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Takemasa K, Kato T, Narita Y, Kato M, Yamazaki Y, Ouchi H, Oyama S, Yamaguchi H, Wada H, Murakami M. The impact of different setup methods on the dose distribution in proton therapy for hepatocellular carcinoma. J Appl Clin Med Phys 2021; 22:63-71. [PMID: 33595910 PMCID: PMC7984466 DOI: 10.1002/acm2.13178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/08/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose To investigate the impact of different setup methods, vertebral body matching (VM), diaphragm matching (DM), and marker matching (MM), on the dose distribution in proton therapy (PT) for hepatocellular carcinoma (HCC). Materials and Methods Thirty‐eight HCC lesions were studied retrospectively to assess changes in the dose distribution on two computed tomography (CT) scans. One was for treatment planning (1st‐CT), and the other was for dose confirmation acquired during the course of PT (2nd‐CT). The dose coverage of the clinical target volume (CTV‐D98) and normal liver volume that received 30 Gy relative biological effectiveness (RBE) (liver‐V30) were evaluated under each condition. Initial treatment planning on the 1st‐CT was defined as reference, and three dose distributions recalculated using VM, DM, and MM on the 2nd‐CT, were compared to it, respectively. In addition, the relationship between the CTV‐D98 of each method and the distance between the center of mass (COM) of the CTV and the right diaphragm top was evaluated. Results For CTV‐D98, significant differences were observed between the reference and VM and DM, respectively (P = 0.013, P = 0.015). There were also significant differences between MM and VM and DM, respectively (P = 0.018, P = 0.036). Regarding liver‐V30, there was no significant difference in any of the methods, and there were no discernable difference due to the different setup methods. In DM, only two out of 34 cases with a distance from right diaphragm top to COM of CTV of 90 mm or less that CTV‐D98 difference was 5% or more and CTV‐D98 was worse than VM were confirmed. Conclusion Although MM is obviously the most effective method, it is suggested that DM may be particularly effective in cases where the distance from right diaphragm top to COM of CTV of 90 mm or less.
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Affiliation(s)
- Kimihiro Takemasa
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Takahiro Kato
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima, Japan.,Preparing Section for New Faculty of Medical Science, Fukushima Medical University, Fukushima, Japan
| | - Yuki Narita
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Masato Kato
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Yuhei Yamazaki
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Hisao Ouchi
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Sho Oyama
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Hisashi Yamaguchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
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21
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Burbadge C, Kasanda E, Bildstein V, Dublin G, Olaizola B, Höhr C, Mücher D. Proton therapy range verification method via delayed γ-ray spectroscopy of a molybdenum tumour marker. Phys Med Biol 2021; 66:025005. [PMID: 32998122 DOI: 10.1088/1361-6560/abbd16] [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
In this work, a new method of range verification for proton therapy (PT) is experimentally demonstrated for the first time. If a metal marker is implanted near the tumour site, its response to proton activation will result in the emission of characteristic γ rays. The relative intensity of γ rays originating from competing fusion-evaporation reaction channels provides a unique signature of the average proton energy at the marker, and by extension the beam's range, in vivo and in real time. The clinical feasibility of this method was investigated at the PT facility at TRIUMF with a proof-of-principle experiment which irradiated a naturally-abundant molybdenum foil at various proton beam energies. Delayed characteristic γ rays were measured with two Compton-shielded LaBr3 scintillators. The technique was successfully demonstrated by relating the relative intensity of two γ-ray peaks to the energy of the beam at the Mo target, opening the door to future clinical applications where the range of the beam can be verified in real time.
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Affiliation(s)
- C Burbadge
- Department of Physics, University of Guelph, 50 Stone Rd E, Guelph, Ontario, N1G 2W1, Canada
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22
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Kasanda E, Burbadge C, Bildstein V, Turko J, Spyrou A, Höhr C, Mücher D. GEANT4 simulation of a range verification method using delayed γ spectroscopy of a 92Mo marker. Phys Med Biol 2020; 65:245047. [PMID: 33331299 DOI: 10.1088/1361-6560/abbd15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this work, we propose a novel technique for in-vivo proton therapy range verification. This technique makes use of a molybdenum hadron tumour marker, implanted at a short distance from the clinical treatment volume. Signals emitted from the marker during treatment can provide a direct measurement of the proton beam energy at the marker's position. Fusion-evaporation reactions between the proton beam and marker nucleus result in the emission of delayed characteristic γ rays, which are detected off-beam for an improved signal-to-noise ratio. In order to determine the viability of this technique and to establish an experimental setup for future work, the Monte Carlo package GEANT4 was used in combination with ROOT to simulate a treatment scenario with the new method outlined in this work. These simulations show that the intensity of delayed γ rays produced from competing reactions yields a precise measurement of the range of the proton beam relative to the marker, with sub-millimetre uncertainty.
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Affiliation(s)
- E Kasanda
- Department of Physics, University of Guelph, 50 Stone Rd E, Guelph, ON, N1G 2W1, Canada
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23
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Thomas M, De Roover R, van der Merwe S, Lambrecht M, Defraene G, Haustermans K. The use of tumour markers in oesophageal cancer to quantify setup errors and baseline shifts during treatment. Clin Transl Radiat Oncol 2020; 26:8-14. [PMID: 33251342 PMCID: PMC7677672 DOI: 10.1016/j.ctro.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 12/24/2022] Open
Abstract
Implantation of solid gold markers safe. Inter-fractional motion for markers in distal oesophagus largest cranio-caudally. Reduced radiotherapy treatment margins with soft-tissue vs. bony-anatomy matching. Impact of intra-fractional baseline shifts on margin calculation rather small.
Purpose To prospectively evaluate the feasibility of solid gold marker placement in oesophageal cancer patients and to quantify inter-fractional and intra-fractional (baseline shift) marker motion during radiation treatment. Radiotherapy target margins and matching strategies were investigated. Materials/methods Thirty-four markers were implanted by echo-endoscopy in 10 patients. Patients received a planning 4D CT, daily pre-treatment cone-beam CT (CBCT) and a post-treatment CBCT for at least five fractions. For fractions with both pre- and post-treatment CBCT, marker displacement between planning CT and pre-treatment CBCT (inter-fractional) and between pre-treatment and post-treatment CBCT (intra-fractional; only for fractions without rotational treatment couch correction) were calculated in left–right (LR), cranio-caudal (CC) and anterior-posterior (AP) direction after bony-anatomy and soft-tissue matching. Systematic/random setup errors were estimated; treatment margins were calculated. Results No serious adverse events occurred. Twenty-three (67.6%) markers were visible during radiotherapy (n = 3 middle oesophagus, n = 16 distal oesophagus, n = 4 proximal stomach). Margins for inter-fractional displacement after bony-anatomy match depended on the localisation of the primary tumour and were 11.2 mm (LR), 16.4 mm (CC) and 8.2 mm (AP) for distal markers. Soft-tissue matching reduced the CC margin for these markers (16.4 mm to 10.5 mm). The mean intra-fractional shift of 12 distal markers was 0.4 mm (LR), 2.3 mm (CC) and 0.7 mm (AP). Inclusion of this shift resulted in treatment margins for distal markers of 12.8 mm (LR), 17.3 mm (CC) and 10.4 mm (AP) after bony-anatomy matching and 12.4 mm (LR), 11.4 mm (CC) and 9.7 mm (AP) after soft-tissue matching. Conclusion This study demonstrated that the implantation of gold markers was safe, albeit less stable compared to other marker types. Inter-fractional motion was largest cranio-caudally for markers in the distal oesophagus, which was reduced after soft-tissue compared to bony-anatomy matching. The impact of intra-fractional baseline shifts on margin calculation was rather small.
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Key Words
- 2D, two-dimensional
- 3D, three-dimensional
- 4D, four-dimensional
- AP, anterior-posterior
- CBCT, cone-beam computed tomography
- CC, cranio-caudal
- CT, computed tomography
- CTV, clinical target volume
- CTVtotal, total clinical target volume
- DoF, degree-of-freedom
- EUS, endoscopic ultrasound
- Esophageal cancer
- FDG-PET/CT, fluorodeoxyglucose positron emission tomography with integrated computed tomography
- Fiducial gold markers
- GM, grand mean
- GTV, gross tumour volume
- IMRT, intensity modulated radiation therapy
- Inter-fractional motion
- Intra-fractional baseline shifts
- LR, left-right
- MRI, magnetic resonance imaging
- Matching strategies
- OAR, organ at risk
- PTV, planning target volume
- Radiotherapy treatment margins
- iCTV, internal clinical target volume
- kV, kilovoltage
- nCRT, neoadjuvant chemoradiation
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Affiliation(s)
- Melissa Thomas
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium.,University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Robin De Roover
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium.,University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Schalk van der Merwe
- University Hospitals Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
| | - Maarten Lambrecht
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium.,University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Gilles Defraene
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | - Karin Haustermans
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium.,University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
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24
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Takayanagi T, Uesaka T, Nakamura Y, Unlu MB, Kuriyama Y, Uesugi T, Ishi Y, Kudo N, Kobayashi M, Umegaki K, Tomioka S, Matsuura T. On-line range verification for proton beam therapy using spherical ionoacoustic waves with resonant frequency. Sci Rep 2020; 10:20385. [PMID: 33230208 PMCID: PMC7683547 DOI: 10.1038/s41598-020-77422-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/10/2020] [Indexed: 01/01/2023] Open
Abstract
In contrast to conventional X-ray therapy, proton beam therapy (PBT) can confine radiation doses to tumours because of the presence of the Bragg peak. However, the precision of the treatment is currently limited by the uncertainty in the beam range. Recently, a unique range verification methodology has been proposed based on simulation studies that exploit spherical ionoacoustic waves with resonant frequency (SPIREs). SPIREs are emitted from spherical gold markers in tumours initially introduced for accurate patient positioning when the proton beam is injected. These waves have a remarkable property: their amplitude is linearly correlated with the residual beam range at the marker position. Here, we present proof-of-principle experiments using short-pulsed proton beams at the clinical dose to demonstrate the feasibility of using SPIREs for beam-range verification with submillimetre accuracy. These results should substantially contribute to reducing the range uncertainty in future PBT applications.
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Affiliation(s)
- Taisuke Takayanagi
- Graduate School of Biomedical Science and Engineering, Hokkaido University, North-13 West-8, Kita-ku, Sapporo, Hokkaido, 060-8628, Japan.,Hitachi Ltd, 1-1 7-chome, Omika-cho, Hitachi-shi, Ibaraki, 319-1292, Japan
| | - Tomoki Uesaka
- Graduate School of Biomedical Science and Engineering, Hokkaido University, North-13 West-8, Kita-ku, Sapporo, Hokkaido, 060-8628, Japan
| | - Yuta Nakamura
- Graduate School of Engineering, Hokkaido University, North-13 West-8, Kita-ku, Sapporo, Hokkaido, 060-8628, Japan
| | - Mehmet Burcin Unlu
- Department of Physics, Bogazici University, Bebek, Istanbul, 34342, Turkey
| | - Yasutoshi Kuriyama
- Institute for Integrated Radiation and Nuclear Science, Kyoto University, Kumatori, Osaka, 590-0494, Japan
| | - Tomonori Uesugi
- Institute for Integrated Radiation and Nuclear Science, Kyoto University, Kumatori, Osaka, 590-0494, Japan
| | - Yoshihiro Ishi
- Institute for Integrated Radiation and Nuclear Science, Kyoto University, Kumatori, Osaka, 590-0494, Japan
| | - Nobuki Kudo
- Faculty of Information Science and Technology, Hokkaido University, North-14, West-9, Kita-ku, Sapporo, Hokkaido, 060-0814, Japan
| | - Masanori Kobayashi
- Planetary Exploration Research Center, Chiba Institute of Technology, Narashino, Chiba, 275-0016, Japan
| | - Kikuo Umegaki
- Faculty of Engineering, Hokkaido University, North-13 West-8, Kita-ku, Sapporo, Hokkaido, 060-8628, Japan.,Proton Beam Therapy Center, Hokkaido University Hospital, North-15 West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Satoshi Tomioka
- Faculty of Engineering, Hokkaido University, North-13 West-8, Kita-ku, Sapporo, Hokkaido, 060-8628, Japan
| | - Taeko Matsuura
- Faculty of Engineering, Hokkaido University, North-13 West-8, Kita-ku, Sapporo, Hokkaido, 060-8628, Japan. .,Proton Beam Therapy Center, Hokkaido University Hospital, North-15 West-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
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25
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Farr JB, Moyers MF, Allgower CE, Bues M, Hsi WC, Jin H, Mihailidis DN, Lu HM, Newhauser WD, Sahoo N, Slopsema R, Yeung D, Zhu XR. Clinical commissioning of intensity-modulated proton therapy systems: Report of AAPM Task Group 185. Med Phys 2020; 48:e1-e30. [PMID: 33078858 DOI: 10.1002/mp.14546] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023] Open
Abstract
Proton therapy is an expanding radiotherapy modality in the United States and worldwide. With the number of proton therapy centers treating patients increasing, so does the need for consistent, high-quality clinical commissioning practices. Clinical commissioning encompasses the entire proton therapy system's multiple components, including the treatment delivery system, the patient positioning system, and the image-guided radiotherapy components. Also included in the commissioning process are the x-ray computed tomography scanner calibration for proton stopping power, the radiotherapy treatment planning system, and corresponding portions of the treatment management system. This commissioning report focuses exclusively on intensity-modulated scanning systems, presenting details of how to perform the commissioning of the proton therapy and ancillary systems, including the required proton beam measurements, treatment planning system dose modeling, and the equipment needed.
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Affiliation(s)
- Jonathan B Farr
- Department of Medical Physics, Applications of Detectors and Accelerators to Medicine, Meyrin, 1217, Switzerland
| | | | - Chris E Allgower
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, 46202, USA
| | - Martin Bues
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, 85259, USA
| | - Wen-Chien Hsi
- University of Florida Proton Therapy Institute, University of Florida, Jacksonville, FL, 32206, USA
| | - Hosang Jin
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Dimitris N Mihailidis
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Hsiao-Ming Lu
- Department of Radiation Oncology, Hefei Ion Medical Center, 1700 Changning Avenue, Gaoxin District, Hefei, Anhui, 230088, China
| | - Wayne D Newhauser
- Department of Physics & Astronomy, Louisiana State University, Baton Rouge, LA, 70803, USA.,Mary Bird Perkins Cancer Center, Baton Rouge, LA, 70809, USA
| | - Narayan Sahoo
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Roelf Slopsema
- Department of Radiation Oncology, Emory Proton Therapy Center, Emory University, Atlanta, GA, 30322, USA
| | - Daniel Yeung
- Saudi Proton Therapy Center, King Fahad Medical City, Riyadh, Riyadh Province, 11525, Saudi Arabia
| | - X Ronald Zhu
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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26
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Hansen AE, Henriksen JR, Jølck RI, Fliedner FP, Bruun LM, Scherman J, Jensen AI, Munck af Rosenschöld P, Moorman L, Kurbegovic S, de Blanck SR, Larsen KR, Clementsen PF, Christensen AN, Clausen MH, Wang W, Kempen P, Christensen M, Viby NE, Persson G, Larsen R, Conradsen K, McEvoy FJ, Kjaer A, Eriksen T, Andresen TL. Multimodal soft tissue markers for bridging high-resolution diagnostic imaging with therapeutic intervention. SCIENCE ADVANCES 2020; 6:eabb5353. [PMID: 32875113 PMCID: PMC7438096 DOI: 10.1126/sciadv.abb5353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/07/2020] [Indexed: 05/11/2023]
Abstract
Diagnostic imaging often outperforms the surgeon's ability to identify small structures during therapeutic procedures. Smart soft tissue markers that translate the sensitivity of diagnostic imaging into optimal therapeutic intervention are therefore highly warranted. This paper presents a unique adaptable liquid soft tissue marker system based on functionalized carbohydrates (Carbo-gel). The liquid state of these markers allows for high-precision placement under image guidance using thin needles. Based on step-by-step modifications, the image features and mechanical properties of markers can be optimized to bridge diagnostic imaging and specific therapeutic interventions. The performance of Carbo-gel is demonstrated for markers that (i) have radiographic, magnetic resonance, and ultrasound visibility; (ii) are palpable and visible; and (iii) are localizable by near-infrared fluorescence and radio guidance. The study demonstrates encouraging proof of concept for the liquid marker system as a well-tolerated multimodal imaging marker that can improve image-guided radiotherapy and surgical interventions, including robotic surgery.
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Affiliation(s)
- Anders E. Hansen
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Jonas R. Henriksen
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Rasmus I. Jølck
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Frederikke P. Fliedner
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Copenhagen University Hospital (Rigshospitalet) and University of Copenhagen, Copenhagen, DK-2200, Denmark
| | - Linda M. Bruun
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Jonas Scherman
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund SE-222 42, Sweden
| | - Andreas I. Jensen
- DTU Health Technology, The Hevesy Laboratory, Technical University of Denmark, Roskilde DK-4000, Denmark
| | - Per. Munck af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund SE-222 42, Sweden
| | - Lilah Moorman
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, Frederiksberg DK-1870, Denmark
| | - Sorel Kurbegovic
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Copenhagen University Hospital (Rigshospitalet) and University of Copenhagen, Copenhagen, DK-2200, Denmark
| | - Steen R. de Blanck
- Department of Oncology, Copenhagen University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark
| | - Klaus R. Larsen
- Department of Respiratory Medicine, Copenhagen University Hospital (Bispebjerg and Frederiksberg Hospital), Copenhagen DK-2400, Denmark
| | - Paul F. Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, DK-2100, Denmark
| | - Anders N. Christensen
- DTU Compute, Section for Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Mads H. Clausen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark
| | - Wenbo Wang
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Paul Kempen
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Merete Christensen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark
| | - Niels-Erik Viby
- Department of Cardiothoracic Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark
| | - Gitte Persson
- Department of Oncology, Herlev-Gentofte Hospital, Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Rasmus Larsen
- DTU Compute, Section for Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Knut Conradsen
- DTU Compute, Section for Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Fintan J. McEvoy
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, Frederiksberg DK-1870, Denmark
| | - Andreas Kjaer
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Copenhagen University Hospital (Rigshospitalet) and University of Copenhagen, Copenhagen, DK-2200, Denmark
| | - Thomas Eriksen
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, Frederiksberg DK-1870, Denmark
| | - Thomas L. Andresen
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
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Evaluation of a Novel Liquid Fiducial Marker, BioXmark ®, for Small Animal Image-Guided Radiotherapy Applications. Cancers (Basel) 2020; 12:cancers12051276. [PMID: 32443537 PMCID: PMC7280978 DOI: 10.3390/cancers12051276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022] Open
Abstract
BioXmark® (Nanovi A/S, Denmark) is a novel fiducial marker based on a liquid, iodine-based and non-metallic formulation. BioXmark® has been clinically validated and reverse translated to preclinical models to improve cone-beam CT (CBCT) target delineation in small animal image-guided radiotherapy (SAIGRT). However, in phantom image analysis and in vivo evaluation of radiobiological response after the injection of BioXmark® are yet to be reported. In phantom measurements were performed to compare CBCT imaging artefacts with solid fiducials and determine optimum imaging parameters for BioXmark®. In vivo stability of BioXmark® was assessed over a 5-month period, and the impact of BioXmark® on in vivo tumour response from single-fraction and fractionated X-ray exposures was investigated in a subcutaneous syngeneic tumour model. BioXmark® was stable, well tolerated and detectable on CBCT at volumes ≤10 µL. Our data showed imaging artefacts reduced by up to 84% and 89% compared to polymer and gold fiducial markers, respectively. BioXmark® was shown to have no significant impact on tumour growth in control animals, but changes were observed in irradiated animals injected with BioXmark® due to alterations in dose calculations induced by the sharp contrast enhancement. BioXmark® is superior to solid fiducials with reduced imaging artefacts on CBCT. With minimal impact on the tumour growth delay, BioXmark® can be implemented in SAIGRT to improve target delineation and reduce set-up errors.
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28
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Sun LC, Su Y, Ding XC, Xu DS, Li CM, Wang L, Li WL, Sun XD, Yu JM, Meng X. In vitro and in vivo evaluation of the safety and efficacy of a novel liquid fiducial marker for image-guided radiotherapy. Oncol Lett 2020; 20:569-580. [PMID: 32565982 PMCID: PMC7286123 DOI: 10.3892/ol.2020.11591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 03/26/2020] [Indexed: 12/30/2022] Open
Abstract
The true extent of a tumor is difficult to visualize, during radiotherapy, using current modalities. In the present study, the safety and feasibility of a mixture of N-butyl cyanoacrylate and lipiodol (NBCA/Lip) was evaluated in order to investigate the optimal combination for application as a fiducial marker for radiotherapy. Four combinations of NBCA/Lip injection (1:1–0.1, 1:1–0.15, 1:3–0.1 and 1:3–0.15 ml) were injected into the subcutaneous tissue of BALB/c mice. The changes in gross histopathology, body weight, skin score, marker volume, neutrophil and macrophage counts were observed to analyze the effects of the different mixing ratios and injection volumes, in order to identify the best combination. Evaluation according to the International Organization for Standardization criteria was further conducted in order to test the biocompatibility of the mixture, including an acute systematic assay with mice, cytotoxicity with L929 fibroblasts and delayed-type hypersensitivity tests with guinea pigs and an intradermal test with rabbits. The results revealed that at the seventh week, 42 markers (42/48; 87.5%) were still visible using computed tomography (CT) imaging. No serious adverse effects were observed throughout the study period; however, the combination of 1:1–0.1 ml had the lowest body weight and worst skin score. A review of the histopathological reaction to NBCA/Lip revealed a combination of acute inflammation, chronic inflammation, granulation tissue, foreign-body reaction and fibrous capsule formation. The 1:1 NBCA combination ratio resulted in the most intense tissue repair reaction and a slower degradation rate of markers. In general, the combination of 1:3–0.15 ml had a better fusion with local tissue, maintained a stable imaging nodule on CT images for 7 weeks and the final biocompatibility test demonstrated its safety. Overall, the findings of the present study demonstrated NBCA/Lip as a safe and feasible fiducial marker, when using the 1:3–0.15 ml combination.
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Affiliation(s)
- Liang-Chao Sun
- Department of Radiation Oncology and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, Shandong 300060, P.R. China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Yi Su
- Department of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University Institution, Yantai, Shandong 264001, P.R. China
| | - Xing-Chen Ding
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Dong-Shui Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Cheng-Ming Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Lu Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Wan-Long Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Xin-Dong Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Jin-Ming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
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Video-based augmented reality combining CT-scan and instrument position data to microscope view in middle ear surgery. Sci Rep 2020; 10:6767. [PMID: 32317726 PMCID: PMC7174368 DOI: 10.1038/s41598-020-63839-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022] Open
Abstract
The aim of the study was to develop and assess the performance of a video-based augmented reality system, combining preoperative computed tomography (CT) and real-time microscopic video, as the first crucial step to keyhole middle ear procedures through a tympanic membrane puncture. Six different artificial human temporal bones were included in this prospective study. Six stainless steel fiducial markers were glued on the periphery of the eardrum, and a high-resolution CT-scan of the temporal bone was obtained. Virtual endoscopy of the middle ear based on this CT-scan was conducted on Osirix software. Virtual endoscopy image was registered to the microscope-based video of the intact tympanic membrane based on fiducial markers and a homography transformation was applied during microscope movements. These movements were tracked using Speeded-Up Robust Features (SURF) method. Simultaneously, a micro-surgical instrument was identified and tracked using a Kalman filter. The 3D position of the instrument was extracted by solving a three-point perspective framework. For evaluation, the instrument was introduced through the tympanic membrane and ink droplets were injected on three middle ear structures. An average initial registration accuracy of 0.21 ± 0.10 mm (n = 3) was achieved with a slow propagation error during tracking (0.04 ± 0.07 mm). The estimated surgical instrument tip position error was 0.33 ± 0.22 mm. The target structures’ localization accuracy was 0.52 ± 0.15 mm. The submillimetric accuracy of our system without tracker is compatible with ear surgery.
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30
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Reidel CA, Schuy C, Horst F, Ecker S, Finck C, Durante M, Weber U. Fluence perturbation from fiducial markers due to edge-scattering measured with pixel sensors for 12C ion beams. Phys Med Biol 2020; 65:085005. [PMID: 32053811 DOI: 10.1088/1361-6560/ab762f] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fiducial markers are nowadays a common tool for patient positioning verification before radiotherapy treatment. These markers should be visible on x-ray projection imaging, produce low streak artifacts on CTs and induce small dose perturbations due to edge-scattering effects during the ion-beam therapy treatment. In this study, the latter effect was investigated and the perturbations created by the markers were evaluated with a new measurement method using a tracker system composed of six CMOS pixel sensors. The present method enables the determination of the particle trajectory before and after the target. The experiments have been conducted at the Marburg Ion Beam Therapy Center with carbon ion beams and the measurement concept was validated by comparison with radiochromic films. This work shows that the new method is very efficient and precise to measure the perturbations due to fiducial markers with a tracker system. Three dimensional fluence distributions of all particle trajectories were reconstructed and the maximum cold spots due to the markers and their position along the beam axis were quantified. In this study, four small commercial markers with different geometries and materials (gold and carbon-coated ZrO2) were evaluated. The gold markers showed stronger perturbations than the lower density ones. However, it is important to consider that low density and low atomic number fiducial markers are not always visible on x-ray projections.
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Affiliation(s)
- Claire-Anne Reidel
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstrasse 1, 64291 Darmstadt, Germany. Université de Strasbourg, CNRS, IPHC UMR 7871, F-67000 Strasbourg, France
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Tryggestad EJ, Liu W, Pepin MD, Hallemeier CL, Sio TT. Managing treatment-related uncertainties in proton beam radiotherapy for gastrointestinal cancers. J Gastrointest Oncol 2020; 11:212-224. [PMID: 32175124 DOI: 10.21037/jgo.2019.11.07] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In recent years, there has been rapid adaption of proton beam radiotherapy (RT) for treatment of various malignancies in the gastrointestinal (GI) tract, with increasing number of institutions implementing intensity modulated proton therapy (IMPT). We review the progress and existing literature regarding the technical aspects of RT planning for IMPT, and the existing tools that can help with the management of uncertainties which may impact the daily delivery of proton therapy. We provide an in-depth discussion regarding range uncertainties, dose calculations, image guidance requirements, organ and body cavity filling consideration, implanted devices and hardware, use of fiducials, breathing motion evaluations and both active and passive motion management methods, interplay effect, general IMPT treatment planning considerations including robustness plan evaluation and optimization, and finally plan monitoring and adaptation. These advances have improved confidence in delivery of IMPT for patients with GI malignancies under various scenarios.
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Affiliation(s)
- Erik J Tryggestad
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic Phoenix, Phoenix, AZ, USA
| | - Mark D Pepin
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic Phoenix, Phoenix, AZ, USA
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Suzuki T, Saito M, Onishi H, Mochizuki K, Satani K, Yamazaki A, Miura K, Taka S, Sano N, Komiyama T, Takahashi H. Comparison of CT artifacts and image recognition of various fiducial markers including two types of thinner fiducial markers for CyberKnife treatment. Rep Pract Oncol Radiother 2020; 25:117-124. [DOI: 10.1016/j.rpor.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/04/2019] [Accepted: 12/02/2019] [Indexed: 11/25/2022] Open
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Shcherbakova Y, Bartels LW, Mandija S, Beld E, Seevinck PR, van der Voort van Zyp JRN, Kerkmeijer LGW, Moonen CTW, Lagendijk JJW, van den Berg CAT. Visualization of gold fiducial markers in the prostate using phase-cycled bSSFP imaging for MRI-only radiotherapy. ACTA ACUST UNITED AC 2019; 64:185001. [DOI: 10.1088/1361-6560/ab35c3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Quantitative evaluation of image recognition performance of fiducial markers in real-time tumor-tracking radiation therapy. Phys Med 2019; 65:33-39. [DOI: 10.1016/j.ejmp.2019.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 11/15/2022] Open
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Bertholet J, Knopf A, Eiben B, McClelland J, Grimwood A, Harris E, Menten M, Poulsen P, Nguyen DT, Keall P, Oelfke U. Real-time intrafraction motion monitoring in external beam radiotherapy. Phys Med Biol 2019; 64:15TR01. [PMID: 31226704 PMCID: PMC7655120 DOI: 10.1088/1361-6560/ab2ba8] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/10/2019] [Accepted: 06/21/2019] [Indexed: 12/25/2022]
Abstract
Radiotherapy (RT) aims to deliver a spatially conformal dose of radiation to tumours while maximizing the dose sparing to healthy tissues. However, the internal patient anatomy is constantly moving due to respiratory, cardiac, gastrointestinal and urinary activity. The long term goal of the RT community to 'see what we treat, as we treat' and to act on this information instantaneously has resulted in rapid technological innovation. Specialized treatment machines, such as robotic or gimbal-steered linear accelerators (linac) with in-room imaging suites, have been developed specifically for real-time treatment adaptation. Additional equipment, such as stereoscopic kilovoltage (kV) imaging, ultrasound transducers and electromagnetic transponders, has been developed for intrafraction motion monitoring on conventional linacs. Magnetic resonance imaging (MRI) has been integrated with cobalt treatment units and more recently with linacs. In addition to hardware innovation, software development has played a substantial role in the development of motion monitoring methods based on respiratory motion surrogates and planar kV or Megavoltage (MV) imaging that is available on standard equipped linacs. In this paper, we review and compare the different intrafraction motion monitoring methods proposed in the literature and demonstrated in real-time on clinical data as well as their possible future developments. We then discuss general considerations on validation and quality assurance for clinical implementation. Besides photon RT, particle therapy is increasingly used to treat moving targets. However, transferring motion monitoring technologies from linacs to particle beam lines presents substantial challenges. Lessons learned from the implementation of real-time intrafraction monitoring for photon RT will be used as a basis to discuss the implementation of these methods for particle RT.
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Affiliation(s)
- Jenny Bertholet
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS
Foundation Trust, London, United
Kingdom
- Author to whom any correspondence should be
addressed
| | - Antje Knopf
- Department of Radiation Oncology,
University Medical Center
Groningen, University of Groningen, The
Netherlands
| | - Björn Eiben
- Department of Medical Physics and Biomedical
Engineering, Centre for Medical Image Computing, University College London, London,
United Kingdom
| | - Jamie McClelland
- Department of Medical Physics and Biomedical
Engineering, Centre for Medical Image Computing, University College London, London,
United Kingdom
| | - Alexander Grimwood
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS
Foundation Trust, London, United
Kingdom
| | - Emma Harris
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS
Foundation Trust, London, United
Kingdom
| | - Martin Menten
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS
Foundation Trust, London, United
Kingdom
| | - Per Poulsen
- Department of Oncology, Aarhus University Hospital, Aarhus,
Denmark
| | - Doan Trang Nguyen
- ACRF Image X Institute, University of Sydney, Sydney,
Australia
- School of Biomedical Engineering,
University of Technology
Sydney, Sydney, Australia
| | - Paul Keall
- ACRF Image X Institute, University of Sydney, Sydney,
Australia
| | - Uwe Oelfke
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS
Foundation Trust, London, United
Kingdom
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Schneider S, Aust DE, Brückner S, Welsch T, Hampe J, Troost EGC, Hoffmann AL. Detectability and structural stability of a liquid fiducial marker in fresh ex vivo pancreas tumour resection specimens on CT and 3T MRI. Strahlenther Onkol 2019; 195:756-763. [PMID: 31143995 DOI: 10.1007/s00066-019-01474-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/03/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To test the detectability of a liquid fiducial marker injected into ex vivo pancreas tumour tissue on magnetic resonance imaging (MRI) and computed tomography (CT). Furthermore, its injection performance using different needle sizes and its structural stability after fixation in formaldehyde were investigated. METHODS Liquid fiducial markers with a volume of 20-100 µl were injected into freshly resected pancreas specimens of three patients with suspected adenocarcinoma. X‑ray guided injection was performed using different needle sizes (18 G, 22 G, 25 G). The specimens were scanned on MRI and CT with clinical protocols. The markers were segmented on CT by signal thresholding. Marker detectability in MRI was assessed in the registered segmentations. Marker volume on CT was compared to the injected volume as a measure of backflow. RESULTS Markers with a volume ≥20 µl were detected as hyperintensity on X‑ray and CT. On T1- and T2-weighted 3T MRI, marker sizes ranging from 20-100 µl were visible as hypointensity. Since most markers were non-spherical, MRI detectability was poor and their differentiation from hypointensities caused by air cavities or surgical clips was only feasible with a reference CT. Marker backflow was only observed when using an 18-G needle. A volume decrease of 6.6 ± 13.0% was observed after 24 h in formaldehyde and, with the exception of one instance, no wash-out occurred. CONCLUSIONS The liquid fiducial marker injected in ex vivo pancreatic resection specimen was visible as hyperintensity on kV X‑ray and CT and as hypointensity on MRI. The marker's size was stable in formaldehyde. A marker volume of ≥50 µL is recommended in clinically used MRI sequences. In vivo injection is expected to improve the markers sphericity due to persisting metabolism and thereby enhance detectability on MRI.
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Affiliation(s)
- Sergej Schneider
- Institute of Radiooncology-OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany. .,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, PF 41, 01307, Dresden, Germany.
| | - Daniela E Aust
- Institute of Pathology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Brückner
- Medical Department 1, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thilo Welsch
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jochen Hampe
- Medical Department 1, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Esther G C Troost
- Institute of Radiooncology-OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, PF 41, 01307, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), partner site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden; and Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Aswin L Hoffmann
- Institute of Radiooncology-OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, PF 41, 01307, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Coronel E, Cazacu IM, Sakuraba A, Luzuriaga Chavez AA, Uberoi A, Geng Y, Tomizawa Y, Saftoiu A, Shin EJ, Taniguchi CM, Koong AC, Herman JM, Bhutani MS. EUS-guided fiducial placement for GI malignancies: a systematic review and meta-analysis. Gastrointest Endosc 2019; 89:659-670.e18. [PMID: 30445001 DOI: 10.1016/j.gie.2018.10.047] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/28/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Image-guided radiotherapy (IGRT) allows the delivery of radiation with high precision to a target lesion while minimizing toxicity to surrounding tissues. EUS provides excellent visualization of GI tumors and consequently is being used for fiducial placement with increased frequency. Our goal was to perform a systematic review and meta-analysis of studies evaluating the technical aspects, safety, and efficacy of EUS fiducial placement for IGRT in GI malignancies. METHODS A systematic literature search was carried out in the following databases: Medline, PubMed, Embase, Web of Science, and Cochrane Library, using Medical Subject Headings terms combined with text words. A random effects model was used to determine pooled proportions of technical success, migration, and adverse event rates. Heterogeneity was assessed using the I2 statistic. Publication bias was assessed visually using a funnel plot and by the Begg and Egger tests. RESULTS Nine full articles and 5 abstracts reporting on 1155 patients, 49% from a single study by Dhadham et al, were included in the meta-analysis. The pooled rate of technical success was 98% (95% confidence interval [CI], 96-99). Moderate heterogeneity (I2 = 34.18) was present, which appeared to be due to variable sample sizes. Publication bias was present, suggesting that studies with less-substantial outcomes may have not been reported (Begg test, P = .87; Egger test, P < .01). Pooled rates for fiducial migration and adverse events were 3% (95% CI, 1.0-8.0) and 4% (95% CI, 3-7), respectively. CONCLUSIONS Our meta-analysis showed that EUS-guided insertion of gold fiducials for IGRT is technically feasible and safe. Further controlled studies assessing its long-term effectiveness in GI malignancies are needed.
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Affiliation(s)
- Emmanuel Coronel
- Department of Gastroenterology, Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Irina M Cazacu
- Department of Gastroenterology, Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Atsushi Sakuraba
- Department of Gastroenterology, University of Chicago, Chicago, Illinois, USA
| | | | - Angad Uberoi
- Department of Gastroenterology, Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yimin Geng
- MD Anderson Cancer Center Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yutaka Tomizawa
- Department of Gastroenterology, University of Washington, Seattle, Washington, USA
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Eun Ji Shin
- Division of Gastroenterology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Cullen M Taniguchi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Albert C Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joseph M Herman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Utility of fiducial markers for target positioning in proton radiotherapy of oesophageal carcinoma. Radiother Oncol 2019; 133:28-34. [DOI: 10.1016/j.radonc.2018.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 01/05/2023]
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Lin T, Ma CMC. Positioning errors of metal localization devices with motion artifacts on kV and MV cone beam CT. BJR Open 2019; 1:20190013. [PMID: 33178943 PMCID: PMC7592481 DOI: 10.1259/bjro.20190013] [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: 01/23/2019] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate motion artifacts on kV CBCT and MV CBCT images with metal localization devices for image-guided radiation therapy. METHODS The 8 μ pelvis CBCT template for the Siemens Artiste MVision and Pelvis template for the Varian IX on-board Exact Arms kV were used to acquire CBCT images in this study. Images from both CBCT modalities were compared in CNRs, metal landmark absolute positions, and image volume distortion on three different planes of view. The images were taken on a breathing-simulated thoracic phantom in which several typical metal localization devices were implanted, including clips and wires for breast patients, gold seeds for prostate patients, and BBs as skin markers. To magnify the artifacts, a 4 cm diameter metal ball was also implanted into the thoracic phantom to mimic the metal artifacts. RESULTS For MV CBCT, the CNR at a 4 sec breathing cycle with 1 cm breathing amplitude was 5.0, 3.4 and 4.6 for clips, gold seeds and BBs, respectively while it was 1.5, 2.0 and 1.6 for the kV CBCT. On the images, the kV CBCT showed symmetric streaking artifacts both in the transverse and longitudinal directions relative to the motion direction. The kV CBCT images predicted 89 % of the expected volume, while the MV CBCT images predicted 95 % of the expected volume. The simulated soft tissue observed in the MVCT could not be detected in the kV CBCT. CONCLUSION The MV CBCT images showed better volume prediction, less streaking effects and better CNRs of a moving metal target, i.e. clips, BBs, gold seeds and metal balls than on the kV CBCT images. The MV CBCT was more advantageous compared to the kV CBCT with less motion artifacts for metal localization devices. ADVANCES IN KNOWLEDGE This study would benefit clinicians to prescribe MV CBCT as localization modality for radiation treatment with moving target when metal markers are implanted.
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Affiliation(s)
- Teh Lin
- Department of Radiation Oncology Fox Chase Cancer Center, Temple University, Philadelphia, USA
| | - Chang-Ming Charlie Ma
- Department of Radiation Oncology Fox Chase Cancer Center, Temple University, Philadelphia, USA
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40
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A novel range-verification method using ionoacoustic wave generated from spherical gold markers for particle-beam therapy: a simulation study. Sci Rep 2019; 9:4011. [PMID: 30850625 PMCID: PMC6408528 DOI: 10.1038/s41598-019-38889-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/11/2019] [Indexed: 11/09/2022] Open
Abstract
This study proposes a novel alternative range-verification method for proton beam with acoustic waves generated from spherical metal markers. When proton beam is incident on metal markers, most of the resulting pressure waves are confined in the markers because of the large difference in acoustic impedance between the metal and tissue. However, acoustic waves with frequency equal to marker’s resonant frequency escape this confinement; the marker briefly acts as an acoustic transmitter. Herein, this phenomenon is exploited to measure the range of the proton beam. We test the proposed strategy in 3-D simulations, combining the dose calculations with modelling of acoustic-wave propagation. A spherical gold marker of 2.0 mm diameter was placed in water with a 60 MeV proton beam incident on it. We investigated the dependence of pressure waves on the width of beam pulse and marker position. At short beam pulse, specific high-frequency acoustic waves of 1.62 MHz originating from the marker were observed in wave simulations, whose amplitude correlated with the distance between the marker and Bragg peak. Results indicate that the Bragg peak position can be estimated by measuring the acoustic wave amplitudes from the marker, using a single detector properly designed for the resonance frequency.
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Value of Three-Dimensional Imaging Systems for Image-Guided Carbon Ion Radiotherapy. Cancers (Basel) 2019; 11:cancers11030297. [PMID: 30832346 PMCID: PMC6468538 DOI: 10.3390/cancers11030297] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 02/21/2019] [Accepted: 02/26/2019] [Indexed: 12/16/2022] Open
Abstract
Carbon ion radiotherapy (C-ion RT) allows excellent dose distribution because of the Bragg Peak. Compared with conventional radiotherapy, it delivers a higher dose with a smaller field. However, the dose distribution is sensitive to anatomical changes. Imaging technologies are necessary to reduce uncertainties during treatment, especially for hypofractionated and adaptive radiotherapy (ART). In-room computed tomography (CT) techniques, such as cone-beam CT (CBCT) and CT-on-rails are routinely used in photon centers and play a key role in improving treatment accuracy. For C-ion RT, there is an increasing demand for a three-dimensional (3D) image-guided system because of the limitations of the present two-dimensional (2D) imaging verification technology. This review discusses the current imaging system used in carbon ion centers and the potential benefits of a volumetric image-guided system.
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Miura H, Ozawa S, Enosaki T, Hosono F, Yamada K, Nagata Y. Effect of image quality on correlation modeling error using a fiducial marker in a gimbaled linear accelerator. Rep Pract Oncol Radiother 2019; 24:233-238. [DOI: 10.1016/j.rpor.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 12/27/2018] [Indexed: 11/25/2022] Open
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Landry G, Hua CH. Current state and future applications of radiological image guidance for particle therapy. Med Phys 2018; 45:e1086-e1095. [PMID: 30421805 DOI: 10.1002/mp.12744] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/25/2017] [Accepted: 11/30/2017] [Indexed: 12/27/2022] Open
Abstract
In this review paper, we first give a short overview of radiological image guidance in photon radiotherapy, placing emphasis on the fact that linac based radiotherapy has outpaced particle therapy in the adoption of volumetric image guidance. While cone beam computed tomography (CBCT) has been an established technique in linac treatment rooms for almost two decades, the widespread adoption of volumetric image guidance in particle therapy, whether by means of CBCT or in-room CT imaging, is recent. This lag may be attributable to the bespoke nature and lower number of particle therapy installations, as well as the differences in geometry between those installations and linac treatment rooms. In addition, for particle therapy the so called shift invariance of the dose distribution rarely applies. An overview of the different volumetric image guidance solutions found at modern particle therapy facilities is provided, covering gantry, nozzle, C-arm, and couch-mounted CBCT as well different in-room CT configurations. A summary of the use of in-room volumetric imaging data beyond anatomy-based positioning is also presented as well as the necessary corrections to CBCT images for accurate water equivalent thickness calculation. Finally, the use of non-ionizing imaging modalities is discussed.
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Affiliation(s)
- Guillaume Landry
- Faculty of Physics, Department of Medical Physics, Ludwig-Maximilians-Universität München (LMU Munich), 85748, Garching b. München, Germany
| | - Chia-Ho Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
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Ogino I, Kitagawa M, Watanabe S, Yoshida H, Hata M. Calcium Phosphate Cement Paste Injection as a Fiducial Marker of Cervical Cancer. In Vivo 2018; 32:1609-1615. [PMID: 30348723 DOI: 10.21873/invivo.11421] [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: 06/30/2018] [Revised: 07/14/2018] [Accepted: 07/16/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Calcium phosphate cement (CPC) is used to fill bone voids in dental, orthopedic, and craniofacial applications. This study evaluated CPC marker as an injectable non-metallic fiducial marker. MATERIALS AND METHODS Six patients received 3-5 injections of CPC paste placed at a depth of 10 mm into tumors of the cervix before treatment planning CT (TPCT). Patients were treated with external-beam radiotherapy (EBRT) and high-dose rate brachytherapy (BT). We investigated marker visibility on cone-beam CT (CBCT), T2-weighted MRI, and interfraction of the marker motion for cervical cancer patients. RESULTS Of a total of 22 visible CPC markers at TPCT, 17 CPC markers were visible on the first CBCT. Excluding one patient, all markers were visible on CBCT during EBRT. Of 16 visible CPC markers on CBCT, 13 CPC markers were visible on the magnetic resonance imaging (MRI) obtained before BT. For CPC marker centroid movement, the mean-of-means/systematic variation/random variation were 0.2/0.4/1.4, -1.6/5.1/4.1, and -3.4/2.1/2.8 mm for the left-right, dorsal-ventral, and cranial-caudal directions, respectively. CONCLUSION This is the first report of a CPC marker injected into tumors of the cervix. It can be visualized on CBCT and MRI with reductions in marker loss and artifacts.
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Affiliation(s)
- Ichiro Ogino
- Department of Radiation Oncology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masakazu Kitagawa
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shigenobu Watanabe
- Department of Radiation Oncology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroshi Yoshida
- Center of Gynecologic Endoscopy and Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Masaharu Hata
- Division of Radiation Oncology, Department of Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Yoo GS, Yu JI, Park HC. Proton therapy for hepatocellular carcinoma: Current knowledges and future perspectives. World J Gastroenterol 2018; 24:3090-3100. [PMID: 30065555 PMCID: PMC6064962 DOI: 10.3748/wjg.v24.i28.3090] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/28/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death, as few patients can be treated with currently available curative local modalities. In patients with HCC where curative modalities are not feasible, radiation therapy (RT) has emerged as an alternative or combination therapy. With the development of various technologies, RT has been increasingly used for the management of HCC. Among these advances, proton beam therapy (PBT) has several unique physical properties that give it a finite range in a distal direction, and thus no exit dose along the beam path. Therefore, PBT has dosimetric advantages compared with X-ray therapy for the treatment of HCC. Indeed, various reports in the literature have described the favorable clinical outcomes and improved safety of PBT for HCC patients compared with X-ray therapy. However, there are some technical issues regarding the use of PBT in HCC, including uncertainty of organ motion and inaccuracy during calculation of tissue density and beam range, all of which may reduce the robustness of a PBT treatment plan. In this review, we discuss the physical properties, current clinical data, technical issues, and future perspectives on PBT for the treatment of HCC.
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Affiliation(s)
- Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06351, South Korea
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Maspero M, Seevinck PR, Willems NJW, Sikkes GG, de Kogel GJ, de Boer HCJ, van der Voort van Zyp JRN, van den Berg CAT. Evaluation of gold fiducial marker manual localisation for magnetic resonance-only prostate radiotherapy. Radiat Oncol 2018; 13:105. [PMID: 29871656 PMCID: PMC5989467 DOI: 10.1186/s13014-018-1029-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/13/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The use of intraprostatic gold fiducial markers (FMs) ensures highly accurate and precise image-guided radiation therapy for patients diagnosed with prostate cancer thanks to the ease of localising FMs on photon-based imaging, like Computed Tomography (CT) images. Recently, Magnetic Resonance (MR)-only radiotherapy has been proposed to simplify the workflow and reduce possible systematic uncertainties. A critical, determining factor in the accuracy of such an MR-only simulation will be accurate FM localisation using solely MR images. PURPOSE The aim of this study is to evaluate the performances of manual MR-based FM localisation within a clinical environment. METHODS We designed a study in which 5 clinically involved radiation therapy technicians (RTTs) independently localised the gold FMs implanted in 16 prostate cancer patients in two scenarios: employing a single MR sequence or a combination of sequences. Inter-observer precision and accuracy were assessed for the two scenarios for localisation in terms of 95% limit of agreement on single FMs (LoA)/ centre of mass (LoA CM) and inter-marker distances (IDs), respectively. RESULTS The number of precisely located FMs (LoA <2 mm) increased from 38/48 to 45/48 FMs when localisation was performed using multiple sequences instead of single one. When performing localisation on multiple sequences, imprecise localisation of the FMs (3/48 FMs) occurred for 1/3 implanted FMs in three different patients. In terms of precision, we obtained LoA CM within 0.25 mm in all directions over the precisely located FMs. In terms of accuracy, IDs difference of manual MR-based localisation versus CT-based localisation was on average (±1 STD) 0.6 ±0.6 mm. CONCLUSIONS For both the investigated scenarios, the results indicate that when FM classification was correct, the precision and accuracy are high and comparable to CT-based FM localisation. We found that use of multiple sequences led to better localisation performances compared with the use of single sequence. However, we observed that, due to the presence of calcification and motion, the risk of mislocated patient positioning is still too high to allow the sole use of manual FM localisation. Finally, strategies to possibly overcome the current challenges were proposed.
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Affiliation(s)
- Matteo Maspero
- Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands.
| | - Peter R Seevinck
- Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | - Nicole J W Willems
- Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | - Gonda G Sikkes
- Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | - Geja J de Kogel
- Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | - Hans C J de Boer
- Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
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Miura H, Ozawa S, Matsuura T, Kawakubo A, Hosono F, Yamada K, Nagata Y. 4D modeling in a gimbaled linear accelerator by using gold anchor markers. Rep Pract Oncol Radiother 2018; 23:183-188. [PMID: 29760592 DOI: 10.1016/j.rpor.2018.02.008] [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: 09/11/2017] [Revised: 12/20/2017] [Accepted: 02/16/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose The purpose of this study was to verify whether the dynamic tumor tracking (DTT) feature of a Vero4DRT system performs with 10-mm-long and 0.28 mm diameter gold anchor markers. Methods Gold anchor markers with a length of 10 mm and a diameter of 0.28 mm were used. Gold anchor markers were injected with short and long types into bolus material. These markers were sandwiched by a Tough Water (TW) phantom in the bolus material. For the investigation of 4-dimensional (4D) modeling feasibility under various phantom thicknesses, the TW phantom was added at 2 cm intervals (in upper and lower each by 1 cm). A programmable respiratory motion table was used to simulate breathing-induced organ motion, with an amplitude of 30 mm and a breathing cycle of 3 s. X-ray imaging parameters of 80 kV and 125 kV (320 mA and 5 ms) were used. The least detection error of the fiducial marker was defined as the 4D-modeling limitation. Results The 4D modeling process was attempted using short and long marker types and its limitation with the short and long types was with phantom thicknesses of 6 and 10 cm at 80 kV and 125 kV, respectively. However, the loss in detectability of the gold anchor because of 4D-modeling errors was found to be approximately 6% (2/31) with a phantom thickness of 2 cm under 125 kV. 4D-modeling could be performed except under the described conditions. Conclusions This work showed that a 10-mm-long gold anchor marker in short and long types can be used with DTT for short water equivalent path length site, such as lung cancer patients, in the Vero4DRT system.
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Affiliation(s)
- Hideharu Miura
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan.,Department of Radiation Oncology, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, Japan
| | - Shuichi Ozawa
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan.,Department of Radiation Oncology, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, Japan
| | - Takaaki Matsuura
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan
| | - Atsushi Kawakubo
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan
| | - Fumika Hosono
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan
| | - Kiyoshi Yamada
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan
| | - Yasushi Nagata
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan.,Department of Radiation Oncology, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, Japan
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Dreher C, Oechsner M, Mayinger M, Beierl S, Duma MN, Combs SE, Habermehl D. Evaluation of the tumor movement and the reproducibility of two different immobilization setups for image-guided stereotactic body radiotherapy of liver tumors. Radiat Oncol 2018; 13:15. [PMID: 29378624 PMCID: PMC5789593 DOI: 10.1186/s13014-018-0962-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/22/2018] [Indexed: 01/24/2023] Open
Abstract
Background The purpose of this study is to evaluate the tumor movement and accuracy of patient immobilization in stereotactic body radiotherapy of liver tumors with low pressure foil or abdominal compression. Methods Fifty-four liver tumors treated with stereotactic body radiotherapy were included in this study. Forty patients were immobilized by a vacuum couch with low pressure foil, 14 patients by abdominal compression. We evaluated the ratio of gross tumor volume/internal target volume, the tumor movement in 4D-computed tomography scans and daily online adjustments after cone beam computed tomography scans. Results The ratio of gross tumor volume/internal target volume was smaller with low pressure foil. The tumor movement in 4D-computed tomography scans was smaller with abdominal compression, the cranial movement even significantly different (p = 0.02). The mean online adjustments and their mean absolute values in the vertical, lateral and longitudinal axis were smaller with abdominal compression. The online adjustments were significantly different (p < 0.013), their absolute values in case of the longitudinal axis (p = 0.043). There was no significant difference of the adjustments’ 3D vectors. Conclusions In comparison to low pressure foil, abdominal compression leads to a reduction of the tumor movement. Online adjustments decreased significantly, thus leading to higher accuracy in patient positioning.
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Affiliation(s)
- Constantin Dreher
- Department of Radiation Oncology, University Hospital Rechts der Isar, Technical University München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, University Hospital Rechts der Isar, Technical University München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Rechts der Isar, Technical University München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Stefanie Beierl
- Department of Radiation Oncology, University Hospital Rechts der Isar, Technical University München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Marciana-Nona Duma
- Department of Radiation Oncology, University Hospital Rechts der Isar, Technical University München, Ismaningerstr. 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, University Hospital Rechts der Isar, Technical University München, Ismaningerstr. 22, 81675, Munich, Germany.,Institute of Innovative Radiotherapy, Helmholtzzentrum München, Munich, Germany
| | - Daniel Habermehl
- Department of Radiation Oncology, University Hospital Rechts der Isar, Technical University München, Ismaningerstr. 22, 81675, Munich, Germany. .,Institute of Innovative Radiotherapy, Helmholtzzentrum München, Munich, Germany.
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Dreher C, Habermehl D, Jäkel O, Combs SE. Effective radiotherapeutic treatment intensification in patients with pancreatic cancer: higher doses alone, higher RBE or both? Radiat Oncol 2017; 12:203. [PMID: 29282139 PMCID: PMC5745986 DOI: 10.1186/s13014-017-0945-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/14/2017] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer, especially in case of locally advanced stage has a poor prognosis. Radiotherapy in general can lead to tumor volume reduction, but further improvements, such as ion beam therapy have to be promoted in order to enable dose escalation, which in turn results in better local control rates and downsizing of the tumor itself. Ion beam therapy with its highly promising physical properties is also accompanied by distinct inter- and intrafractional challenges in case of robustness. First clinical results are promising, but further research in motion mitigation and biological treatment planning is necessary, in order to determine the best clinical rationales and conditions of ion beam therapy of pancreatic cancer. This review summarizes the current knowledge and studies on ion beam therapy of pancreatic cancer.
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Affiliation(s)
- Constantin Dreher
- Department of Radiation Oncology, University Hospital Rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22 Munich, Germany
| | - Daniel Habermehl
- Department of Radiation Oncology, University Hospital Rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22 Munich, Germany
- Department of Radiation Sciences (DRS), Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Oberschleißheim, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site München, München, Germany
| | - Oliver Jäkel
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center, INF, 280 Heidelberg, Germany
- Heidelberg Ion Beam Therapy Center (HIT), INF 450, 69120 Heidelberg, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, University Hospital Rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22 Munich, Germany
- Department of Radiation Sciences (DRS), Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Oberschleißheim, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site München, München, Germany
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Maspero M, van den Berg CAT, Zijlstra F, Sikkes GG, de Boer HCJ, Meijer GJ, Kerkmeijer LGW, Viergever MA, Lagendijk JJW, Seevinck PR. Evaluation of an automatic MR-based gold fiducial marker localisation method for MR-only prostate radiotherapy. ACTA ACUST UNITED AC 2017; 62:7981-8002. [DOI: 10.1088/1361-6560/aa875f] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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