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Mylonas A, Booth J, Nguyen DT. A review of artificial intelligence applications for motion tracking in radiotherapy. J Med Imaging Radiat Oncol 2021; 65:596-611. [PMID: 34288501 DOI: 10.1111/1754-9485.13285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022]
Abstract
During radiotherapy, the organs and tumour move as a result of the dynamic nature of the body; this is known as intrafraction motion. Intrafraction motion can result in tumour underdose and healthy tissue overdose, thereby reducing the effectiveness of the treatment while increasing toxicity to the patients. There is a growing appreciation of intrafraction target motion management by the radiation oncology community. Real-time image-guided radiation therapy (IGRT) can track the target and account for the motion, improving the radiation dose to the tumour and reducing the dose to healthy tissue. Recently, artificial intelligence (AI)-based approaches have been applied to motion management and have shown great potential. In this review, four main categories of motion management using AI are summarised: marker-based tracking, markerless tracking, full anatomy monitoring and motion prediction. Marker-based and markerless tracking approaches focus on tracking the individual target throughout the treatment. Full anatomy algorithms monitor for intrafraction changes in the full anatomy within the field of view. Motion prediction algorithms can be used to account for the latencies due to the time for the system to localise, process and act.
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Affiliation(s)
- Adam Mylonas
- ACRF Image X Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jeremy Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, New South Wales, Australia
| | - Doan Trang Nguyen
- ACRF Image X Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,School of Biomedical Engineering, University of Technology Sydney, Sydney, New South Wales, Australia.,Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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2
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Nguyen DT, Keall PJ, Booth JT, Shieh CC, Poulsen PR, O'Brien RT. A real-time IGRT method using a Kalman filter framework to extract 3D positions from 2D projections. Phys Med Biol 2021; 66. [PMID: 34062512 DOI: 10.1088/1361-6560/ac06e3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/01/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE To estimate 3D prostate motion in real-time during irradiation from 2D prostate positions acquired from a kV imager on a standard linear accelerator utilising a Kalman-Filter (KF) framework. The advantage of this novel method is threefold: (1) eliminating the need of an initial learning period, therefore reducing patient imaging dose, (2) more robust against measurement noise and (3) more computationally efficient. METHODS A KF framework was implemented to estimate 3D motion from 2D projection measurements in real-time during prostate cancer treatments. The noise covariance matrix was estimated from the previous 10 measurements. This method did not require an initial learning period as it was initialised using a population covariance matrix. This method was evaluated using a ground-truth motion dataset of 17 prostate cancer patients (536 trajectories) measured with electromagnetic transponders. 3D motion was projected onto a rotating imager (SID=180cm) (pixel size=0.388mm) and rotation speed of 6°/s and 2°/s to simulate VMAT treatments. Gantry-varying additive random noise (±5mm) was added to ground-truth measurements to simulate segmentation error and image quality degradation due to the patient's pelvic bones. For comparison, motion was also estimated using the clinically implemented Gaussian PDF method initialised with 600 projections. RESULTS Without noise, the 3D root-mean-square-errors (3D RMSEs) of motion estimated by the KF method were 0.4±0.1mm and 0.3±0.2mm for 2°/s and 6°/s gantry rotation, respectively. With noise, 3D RMSEs of KF estimated motion were 1.1±0.1 mm for both slow and fast gantry rotation scenarios. In comparison, using a Gaussian PDF method, with noise, 3D RMSE was 2±0.1 mm for both gantry rotation scenarios. CONCLUSION This work presents a fast and accurate method for real-time 2D to 3D motion estimation using a Kalman lter approach to handle the random-walk component of prostate cancer motion. This method has sub-mm accuracy and is highly robust against measurement noise.
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Affiliation(s)
- Doan Trang Nguyen
- Radiation Physics Laboratory - School of Medicine, University of Sydney, Blackburn building, The University of Sydney, Sydney, New South Wales, 2006, AUSTRALIA
| | - Paul J Keall
- Sydney Medical School - Central, University of Sydney, Edward Ford Building A27, The University of Sydney, NSW 2006, Sydney, AUSTRALIA
| | - Jeremy Todd Booth
- Radiation Oncology, Northern Sydney Cancer Centre, Level 1 Royal North Shore Hospital, St Leonards, New South Wales, 2065, AUSTRALIA
| | - Chun-Chien Shieh
- Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, The University of Sydney, Room 479, Blackburn Building, D06NSW 2006, Australia, Sydney, New South Wales, 2006, AUSTRALIA
| | | | - Ricky T O'Brien
- Radiation Physics Laboratory, Sydney Medical School, University of Sydney, NSW 2006, Camperdown, New South Wales, 2039, AUSTRALIA
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Katoh N, Onishi H, Uchinami Y, Inoue T, Kuriyama K, Nishioka K, Shimizu S, Komiyama T, Miyamoto N, Shirato H. Real-Time Tumor-Tracking Radiotherapy and General Stereotactic Body Radiotherapy for Adrenal Metastasis in Patients With Oligometastasis. Technol Cancer Res Treat 2019; 17:1533033818809983. [PMID: 30407123 PMCID: PMC6259059 DOI: 10.1177/1533033818809983] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Precise local radiotherapy for adrenal metastasis can prolong the useful life of patients with oligometastasis. The aim of this retrospective, 2-center study was to establish the safety and effectiveness of real-time tumor-tracking radiotherapy and general stereotactic body radiotherapy in treating patients with adrenal metastatic tumors. Materials and Methods: Thirteen lesions in 12 patients were treated with real-time tumor-tracking radiotherapy (48 Gy in 8 fractions over 2 weeks) and 8 lesions in 8 patients were treated with general stereotactic body radiotherapy (40-50 Gy in 5-8 fractions over 2 weeks or 60-70 Gy in 10 fractions over 2 weeks). Overall survival rates, local control rates, and adverse effects were analyzed. Results: The actuarial overall survival rates for all patients at 1 and 2 years were 78.5% and 45.8%, respectively, with a median follow-up of 17.5 months, and the actuarial local control rates for all tumors at 1 and 2 years were 91.7% and 53.0%, respectively, with a median follow-up of 9 months. A complete local tumor response was obtained in 3 tumors treated by real-time tumor-tracking radiotherapy (lung adenocarcinomas with diameters of 35, 40, and 60 mm). There was a statistically significant difference in the local control between the groups treated by real-time tumor-tracking radiotherapy (100% at 1 year) and general stereotactic body radiotherapy (50% at 1 year; P < .001). No late adverse reactions at Grade 2 or higher were reported for either treatment group. Conclusions: This study showed that although both treatments are safe and effective, the real-time tumor-tracking radiotherapy is more effective than general stereotactic body radiotherapy in local control for adrenal metastasis.
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Affiliation(s)
- Norio Katoh
- 1 Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan.,2 Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| | - Hiroshi Onishi
- 3 Department of Radiology, University of Yamanashi, Chuo, Japan
| | - Yusuke Uchinami
- 1 Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Tetsuya Inoue
- 1 Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan.,2 Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| | - Kengo Kuriyama
- 3 Department of Radiology, University of Yamanashi, Chuo, Japan
| | - Kentaro Nishioka
- 4 Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Shinichi Shimizu
- 2 Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,4 Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | | | - Naoki Miyamoto
- 5 Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroki Shirato
- 2 Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,6 Department of Radiation Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
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Nguyen DT, Booth JT, Caillet V, Hardcastle N, Briggs A, Haddad C, Eade T, O’Brien R, Keall PJ. An augmented correlation framework for the estimation of tumour translational and rotational motion during external beam radiotherapy treatments using intermittent monoscopic x-ray imaging and an external respiratory signal. ACTA ACUST UNITED AC 2018; 63:205003. [DOI: 10.1088/1361-6560/aadf2c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Nguyen DT, Bertholet J, Kim JH, O'Brien R, Booth JT, Poulsen PR, Keall PJ. An interdimensional correlation framework for real-time estimation of six degree of freedom target motion using a single x-ray imager during radiotherapy. Phys Med Biol 2017; 63:015010. [PMID: 29106377 DOI: 10.1088/1361-6560/aa986f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Increasing evidence suggests that intrafraction tumour motion monitoring needs to include both 3D translations and 3D rotations. Presently, methods to estimate the rotation motion require the 3D translation of the target to be known first. However, ideally, translation and rotation should be estimated concurrently. We present the first method to directly estimate six-degree-of-freedom (6DoF) motion from the target's projection on a single rotating x-ray imager in real-time. This novel method is based on the linear correlations between the superior-inferior translations and the motion in the other five degrees-of-freedom. The accuracy of the method was evaluated in silico with 81 liver tumour motion traces from 19 patients with three implanted markers. The ground-truth motion was estimated using the current gold standard method where each marker's 3D position was first estimated using a Gaussian probability method, and the 6DoF motion was then estimated from the 3D positions using an iterative method. The 3D position of each marker was projected onto a gantry-mounted imager with an imaging rate of 11 Hz. After an initial 110° gantry rotation (200 images), a correlation model between the superior-inferior translations and the five other DoFs was built using a least square method. The correlation model was then updated after each subsequent frame to estimate 6DoF motion in real-time. The proposed algorithm had an accuracy (±precision) of -0.03 ± 0.32 mm, -0.01 ± 0.13 mm and 0.03 ± 0.52 mm for translations in the left-right (LR), superior-inferior (SI) and anterior-posterior (AP) directions respectively; and, 0.07 ± 1.18°, 0.07 ± 1.00° and 0.06 ± 1.32° for rotations around the LR, SI and AP axes respectively on the dataset. The first method to directly estimate real-time 6DoF target motion from segmented marker positions on a 2D imager was devised. The algorithm was evaluated using 81 motion traces from 19 liver patients and was found to have sub-mm and sub-degree accuracy.
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Affiliation(s)
- D T Nguyen
- Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, Sydney, Australia
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Nguyen DT, O'Brien R, Kim JH, Huang CY, Wilton L, Greer P, Legge K, Booth JT, Poulsen PR, Martin J, Keall PJ. The first clinical implementation of a real-time six degree of freedom target tracking system during radiation therapy based on Kilovoltage Intrafraction Monitoring (KIM). Radiother Oncol 2017; 123:37-42. [DOI: 10.1016/j.radonc.2017.02.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/17/2017] [Accepted: 02/23/2017] [Indexed: 11/29/2022]
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Wang J, Li F, Dong Y, Song Y, Yuan Z. Clinical study on the influence of motion and other factors on stereotactic radiotherapy in the treatment of adrenal gland tumor. Onco Targets Ther 2016; 9:4295-9. [PMID: 27486331 PMCID: PMC4956153 DOI: 10.2147/ott.s107106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background The aim of this study was to investigate the adrenal tumor motion law and influence factors in the treatment of adrenal gland tumor and provide a reference value basis for determining the planning target volume margins for therapy. Materials and methods The subjects considered in this study were 38 adrenal tumor patients treated with CyberKnife with the placement of 45 gold fiducials. Fiducials were implanted into each adrenal tumor using β-ultrasonic guidance. Motion amplitudes of gold fiducials were measured with a Philips SLS simulator and motion data in the left–right, anterior–posterior, and cranio–caudal directions were obtained. Multiple linear regression models were used to analyze influencing factors. t-Test was used for motion amplitude comparison of different tumor locations along the z-axis. Results The motion distances were 0.1–0.4 cm (0.27±0.07 cm), 0.1–0.5 cm (0.31±0.11 cm), and 0.5–1.2 cm (0.87±0.21 cm) along the x-, y-, and z-axes, respectively. Motion amplitude along the z-axis may be affected by tumor location, but movement along the other axes was not affected by age, height, body mass, location, and size. Conclusion The maximum motion distance was along the z-axis. Therefore, this should be the main consideration when defining the planning target volume safety margin. Due to the proximity of the liver, adrenal gland tumor motion amplitude was smaller on the right than the left. This study analyzed adrenal tumor motion amplitude data to evaluate how motion and other factors influence the treatment of adrenal tumor with a goal of providing a reference for stereotactic radiotherapy boundary determination.
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Affiliation(s)
- Jingsheng Wang
- Department of Radiation Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Fengtong Li
- Department of Radiation Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Yang Dong
- Department of Radiation Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Yongchun Song
- Department of Radiation Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Zhiyong Yuan
- Department of Radiation Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
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Chuma M, Taguchi H, Yamamoto Y, Shimizu S, Nakanishi M, Ogawa K, Sho T, Horimoto H, Kobayashi T, Nakai M, Terashita K, Sakuhara Y, Abo D, Tsukuda Y, Tsunematsu S, Hige S, Kato M, Shirato H, Asaka M. Efficacy of therapy for advanced hepatocellular carcinoma: intra-arterial 5-fluorouracil and subcutaneous interferon with image-guided radiation. J Gastroenterol Hepatol 2011; 26:1123-32. [PMID: 21501224 DOI: 10.1111/j.1440-1746.2011.06745.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM To evaluate the efficacy of intra-arterial 5-fluorouracil (5-FU) and subcutaneous interferon (IFN) combined with image-guided radiation therapy (IGRT) in advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). METHODS Twenty HCC patients with PVTT were treated with 5-FU and IFN combined with image-guided radiation therapy (IGRT) (IGRT group), and as controls, 20 patients with PVTT were treated with 5-FU and IFN alone (non-IGRT group). Overall survival (OS) time, response rates, time to progression (TTP) and safety were compared across groups. RESULTS Complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) of PVTT were 5%, 55%, 40% and 0% in the IGRT group and 0%, 30%, 35% and 35%, in the non-IGRT group, respectively. CR, PR, SD, and PD of the whole tumor were 0%, 35%, 45% and 20% in the IGRT group and 0%, 30%, 35% and 35%, in the non-IGRT group, respectively. Overall median survival was significantly longer in the IGRT group (12.0 months 95% confidence interval [CI], 9.3-17.6 months) than in the non-IGRT group (9.1 months [95% CI, 5.5-11.1 months]) (P = 0.041). TTP was significantly longer in the IGRT group (6.9 months [95% CI, 5.6-10.2 months]) than in the non-IGRT group (4.0 months [95% CI, 3.3-6.4 months]) (P = 0.034). CONCLUSIONS The response rates, median OS time and TTP in patients with advanced HCC with PVTT who received this novel combination therapy of intra-arterial 5-FU and subcutaneous IFN with IGRT are encouraging, and this combination therapy warrants further investigation.
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Affiliation(s)
- Makoto Chuma
- Department of Gastroenterology and Hematology, Hokkaido University, Sapporo, Japan.
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