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Brooks C, Miles E, Hoskin PJ. Radiotherapy trial quality assurance processes: a systematic review. Lancet Oncol 2024; 25:e104-e113. [PMID: 38423056 DOI: 10.1016/s1470-2045(23)00625-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/05/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024]
Abstract
Quality assurance remains a neglected component of many trials, particularly for technical interventions, such as surgery and radiotherapy, for which quality of treatment is an important component in defining outcomes. We aimed to evaluate evidence for the processes used in radiotherapy quality assurance of clinical trials. A systematic review was undertaken focusing on use of a pre-trial outlining benchmark case and subsequent on-trial individual case reviews of outlining for recruited patients. These pre-trial and on-trial checks are used to ensure consistency and standardisation of treatment for each patient recruited to the trial by confirming protocol compliance. Non-adherence to the trial protocol has been shown to have a negative effect on trial outcomes. 29 studies published between January, 2000, and December, 2022, were identified that reported on either outlining benchmark case results or outlining individual case review results, or both. The trials identified varied in their use of radiotherapy quality assurance practices and reporting of outcomes was inconsistent. Deviations from trial protocols were frequent, particularly regarding outlining. Studies correlating benchmark case results with on-trial individual case reviews provided mixed results, meaning firm conclusions could not be drawn regarding the influence of the pre-trial benchmark case on subsequent on-trial performance. The optimal radiotherapy quality assurance processes were unclear, and there was little evidence available. Improved reporting of outcomes from radiotherapy quality assurance programmes is needed to develop an evidence base for the optimal approach to radiotherapy quality assurance in trials.
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Affiliation(s)
- Chloe Brooks
- National Radiotherapy Trials Quality Assurance Group (RTTQA), National Institute for Health and Care Research, Mount Vernon Cancer Centre, Northwood, UK.
| | - Elizabeth Miles
- National Radiotherapy Trials Quality Assurance Group (RTTQA), National Institute for Health and Care Research, Mount Vernon Cancer Centre, Northwood, UK
| | - Peter J Hoskin
- Mount Vernon Cancer Centre and Division of Cancer Sciences, University of Manchester, Manchester, UK
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Casati M, Piffer S, Calusi S, Marrazzo L, Simontacchi G, Di Cataldo V, Greto D, Desideri I, Vernaleone M, Francolini G, Livi L, Pallotta S. Clinical validation of an automatic atlas‐based segmentation tool for male pelvis CT images. J Appl Clin Med Phys 2022; 23:e13507. [PMID: 35064746 PMCID: PMC8906199 DOI: 10.1002/acm2.13507] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose This retrospective work aims to evaluate the possible impact on intra‐ and inter‐observer variability, contouring time, and contour accuracy of introducing a pelvis computed tomography (CT) auto‐segmentation tool in radiotherapy planning workflow. Methods Tests were carried out on five structures (bladder, rectum, pelvic lymph‐nodes, and femoral heads) of six previously treated subjects, enrolling five radiation oncologists (ROs) to manually re‐contour and edit auto‐contours generated with a male pelvis CT atlas created with the commercial software MIM MAESTRO. The ROs first delineated manual contours (M). Then they modified the auto‐contours, producing automatic‐modified (AM) contours. The procedure was repeated to evaluate intra‐observer variability, producing M1, M2, AM1, and AM2 contour sets (each comprising 5 structures × 6 test patients × 5 ROs = 150 contours), for a total of 600 contours. Potential time savings was evaluated by comparing contouring and editing times. Structure contours were compared to a reference standard by means of Dice similarity coefficient (DSC) and mean distance to agreement (MDA), to assess intra‐ and inter‐observer variability. To exclude any automation bias, ROs evaluated both M and AM sets as “clinically acceptable” or “to be corrected” in a blind test. Results Comparing AM to M sets, a significant reduction of both inter‐observer variability (p < 0.001) and contouring time (‐45% whole pelvis, p < 0.001) was obtained. Intra‐observer variability reduction was significant only for bladder and femoral heads (p < 0.001). The statistical test showed no significant bias. Conclusion Our atlas‐based workflow proved to be effective for clinical practice as it can improve contour reproducibility and generate time savings. Based on these findings, institutions are encouraged to implement their auto‐segmentation method.
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Affiliation(s)
- Marta Casati
- Medical Physics Unit Careggi University Hospital Florence Italy
| | - Stefano Piffer
- Department of Experimental and Clinical Biomedical Sciences University of Florence Florence Italy
- National Institute of Nuclear Physics (INFN) Florence Italy
| | - Silvia Calusi
- Department of Experimental and Clinical Biomedical Sciences University of Florence Florence Italy
- National Institute of Nuclear Physics (INFN) Florence Italy
| | - Livia Marrazzo
- Medical Physics Unit Careggi University Hospital Florence Italy
| | | | | | - Daniela Greto
- Radiation Oncology Unit Careggi University Hospital Florence Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences University of Florence Florence Italy
| | - Marco Vernaleone
- Radiation Oncology Unit Careggi University Hospital Florence Italy
| | | | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences University of Florence Florence Italy
- Radiation Oncology Unit Careggi University Hospital Florence Italy
| | - Stefania Pallotta
- Medical Physics Unit Careggi University Hospital Florence Italy
- Department of Experimental and Clinical Biomedical Sciences University of Florence Florence Italy
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Kruis MF. Improving radiation physics, tumor visualisation, and treatment quantification in radiotherapy with spectral or dual-energy CT. J Appl Clin Med Phys 2021; 23:e13468. [PMID: 34743405 PMCID: PMC8803285 DOI: 10.1002/acm2.13468] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 12/11/2022] Open
Abstract
Over the past decade, spectral or dual‐energy CT has gained relevancy, especially in oncological radiology. Nonetheless, its use in the radiotherapy (RT) clinic remains limited. This review article aims to give an overview of the current state of spectral CT and to explore opportunities for applications in RT. In this article, three groups of benefits of spectral CT over conventional CT in RT are recognized. Firstly, spectral CT provides more information of physical properties of the body, which can improve dose calculation. Furthermore, it improves the visibility of tumors, for a wide variety of malignancies as well as organs‐at‐risk OARs, which could reduce treatment uncertainty. And finally, spectral CT provides quantitative physiological information, which can be used to personalize and quantify treatment.
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Kong V, Hansen VN, Hafeez S. Image-guided Adaptive Radiotherapy for Bladder Cancer. Clin Oncol (R Coll Radiol) 2021; 33:350-368. [PMID: 33972024 DOI: 10.1016/j.clon.2021.03.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022]
Abstract
Technological advancement has facilitated patient-specific radiotherapy in bladder cancer. This has been made possible by developments in image-guided radiotherapy (IGRT). Particularly transformative has been the integration of volumetric imaging into the workflow. The ability to visualise the bladder target using cone beam computed tomography and magnetic resonance imaging initially assisted with determining the magnitude of inter- and intra-fraction target change. It has led to greater confidence in ascertaining true anatomy at each fraction. The increased certainty of dose delivered to the bladder has permitted the safe reduction of planning target volume margins. IGRT has therefore improved target coverage with a reduction in integral dose to the surrounding tissue. Use of IGRT to feed back into plan and dose delivery optimisation according to the anatomy of the day has enabled adaptive radiotherapy bladder solutions. Here we undertake a review of the stepwise developments underpinning IGRT and adaptive radiotherapy strategies for external beam bladder cancer radiotherapy. We present the evidence in accordance with the framework for systematic clinical evaluation of technical innovations in radiation oncology (R-IDEAL).
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Affiliation(s)
- V Kong
- Radiation Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - V N Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
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Chen W, Li Y, Dyer BA, Feng X, Rao S, Benedict SH, Chen Q, Rong Y. Deep learning vs. atlas-based models for fast auto-segmentation of the masticatory muscles on head and neck CT images. Radiat Oncol 2020; 15:176. [PMID: 32690103 PMCID: PMC7372849 DOI: 10.1186/s13014-020-01617-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/13/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Impaired function of masticatory muscles will lead to trismus. Routine delineation of these muscles during planning may improve dose tracking and facilitate dose reduction resulting in decreased radiation-related trismus. This study aimed to compare a deep learning model with a commercial atlas-based model for fast auto-segmentation of the masticatory muscles on head and neck computed tomography (CT) images. MATERIAL AND METHODS Paired masseter (M), temporalis (T), medial and lateral pterygoid (MP, LP) muscles were manually segmented on 56 CT images. CT images were randomly divided into training (n = 27) and validation (n = 29) cohorts. Two methods were used for automatic delineation of masticatory muscles (MMs): Deep learning auto-segmentation (DLAS) and atlas-based auto-segmentation (ABAS). The automatic algorithms were evaluated using Dice similarity coefficient (DSC), recall, precision, Hausdorff distance (HD), HD95, and mean surface distance (MSD). A consolidated score was calculated by normalizing the metrics against interobserver variability and averaging over all patients. Differences in dose (∆Dose) to MMs for DLAS and ABAS segmentations were assessed. A paired t-test was used to compare the geometric and dosimetric difference between DLAS and ABAS methods. RESULTS DLAS outperformed ABAS in delineating all MMs (p < 0.05). The DLAS mean DSC for M, T, MP, and LP ranged from 0.83 ± 0.03 to 0.89 ± 0.02, the ABAS mean DSC ranged from 0.79 ± 0.05 to 0.85 ± 0.04. The mean value for recall, HD, HD95, MSD also improved with DLAS for auto-segmentation. Interobserver variation revealed the highest variability in DSC and MSD for both T and MP, and the highest scores were achieved for T by both automatic algorithms. With few exceptions, the mean ∆D98%, ∆D95%, ∆D50%, and ∆D2% for all structures were below 10% for DLAS and ABAS and had no detectable statistical difference (P > 0.05). DLAS based contours had dose endpoints more closely matched with that of the manually segmented when compared with ABAS. CONCLUSIONS DLAS auto-segmentation of masticatory muscles for the head and neck radiotherapy had improved segmentation accuracy compared with ABAS with no qualitative difference in dosimetric endpoints compared to manually segmented contours.
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Affiliation(s)
- Wen Chen
- Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha, China.,Department of Radiation Oncology, University of California Davis Medical Center, 4501 X Street, Suite 0152, Sacramento, California, 95817, USA
| | - Yimin Li
- Department of Radiation Oncology, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Brandon A Dyer
- Department of Radiation Oncology, University of California Davis Medical Center, 4501 X Street, Suite 0152, Sacramento, California, 95817, USA.,Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Xue Feng
- Carina Medical LLC, 145 Graham Ave, A168, Lexington, KY, 40536, USA
| | - Shyam Rao
- Department of Radiation Oncology, University of California Davis Medical Center, 4501 X Street, Suite 0152, Sacramento, California, 95817, USA
| | - Stanley H Benedict
- Department of Radiation Oncology, University of California Davis Medical Center, 4501 X Street, Suite 0152, Sacramento, California, 95817, USA
| | - Quan Chen
- Carina Medical LLC, 145 Graham Ave, A168, Lexington, KY, 40536, USA. .,Department of Radiation Oncology, Markey Cancer Center, University of Kentucky, RM CC063, 800 Rose St, Lexington, KY, 40536, USA.
| | - Yi Rong
- Department of Radiation Oncology, University of California Davis Medical Center, 4501 X Street, Suite 0152, Sacramento, California, 95817, USA.
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Leung J, Lehman M. Contouring experiences amongst Australian, New Zealand and Singaporean radiation oncology trainees. Is it enough? What next? J Med Imaging Radiat Oncol 2019; 63:383-389. [DOI: 10.1111/1754-9485.12858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- John Leung
- University of Adelaide Medical School Adelaide South Australia Australia
- GenesisCare Adelaide South Australia Australia
| | - Margot Lehman
- Department of Radiation Oncology Princess Alexandra Hospital Brisbane Queensland Australia
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Anisotropic Bladder Planning Target Volume in Bladder Radiation Therapy. Pract Radiat Oncol 2019; 9:24-28. [DOI: 10.1016/j.prro.2018.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/09/2018] [Accepted: 07/28/2018] [Indexed: 11/16/2022]
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Role of deformable image registration for delivered dose accumulation of adaptive external beam radiation therapy and brachytherapy in cervical cancer. J Contemp Brachytherapy 2018; 10:542-550. [PMID: 30662477 PMCID: PMC6335550 DOI: 10.5114/jcb.2018.79840] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 11/03/2018] [Indexed: 12/01/2022] Open
Abstract
Purpose Deformable image registration (DIR) can be used to accumulate the absorbed dose distribution of daily image-guided adaptive external beam radiation treatment (EBRT) and brachytherapy (BT). Since dose-volume parameter addition assumes a uniform delivered EBRT dose around the planned BT boost, the added value of DIR over direct addition was investigated for dose accumulation in bladder and rectum. Material and methods For 10 patients (EBRT 46/46.2 GyEQD2, EBRT + BT: D90 85-90 GyEQD2, in equivalent dose in 2 Gy fractions), the actually delivered dose from adaptive volumetric-modulated arc therapy (VMAT)/intensity-modulated radiotherapy (IMRT) EBRT was calculated using the daily anatomy from the cone-beam computed tomography (CBCT) scans acquired prior to irradiation. The CBCT of the first EBRT fraction and the BT planning MRI were registered using DIR. The cumulative dose to the 2 cm3 with the highest dose (D2cm3) from EBRT and BT to the bladder and rectum was calculated and compared to direct addition assuming a uniform EBRT dose (UD). Results Differences (DIR-UD) in the total EBRT + BT dose ranged between –0.2-3.9 GyEQD2 (bladder) and –1.0-3.7 GyEQD2 (rectum). The total EBRT + BT dose calculated with DIR was at most 104% of the dose calculated with the UD method. Conclusions Differences between UD and DIR were small (< 3.9 GyEQD2). The dose delivered with adaptive VMAT/IMRT EBRT to bladder and rectum near the planned BT boost can be considered uniform for the evaluation of bladder/rectum D2cm3.
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Adaptive Radiotherapy for Bladder Cancer—A Systematic Review. J Med Imaging Radiat Sci 2017; 48:199-206. [DOI: 10.1016/j.jmir.2016.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 11/20/2022]
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Evaluating Target Volume Delineation in the Era of Precision Radiotherapy: FRCR, Revalidation and Beyond. Clin Oncol (R Coll Radiol) 2017; 29:436-438. [PMID: 28222956 DOI: 10.1016/j.clon.2017.01.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/22/2022]
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Michienzi A, Kron T, Callahan J, Plumridge N, Ball D, Everitt S. Cone-beam computed tomography for lung cancer - validation with CT and monitoring tumour response during chemo-radiation therapy. J Med Imaging Radiat Oncol 2016; 61:263-270. [DOI: 10.1111/1754-9485.12551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 09/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Alissa Michienzi
- Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - Tomas Kron
- Department of Physical Sciences; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Medical Imaging and Radiation Sciences; Monash University; Clayton Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Victoria Australia
| | - Jason Callahan
- Department of Medical Imaging and Radiation Sciences; Monash University; Clayton Victoria Australia
- Centre for Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Nikki Plumridge
- Division of Radiation Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - David Ball
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Victoria Australia
- Division of Radiation Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Sarah Everitt
- Department of Medical Imaging and Radiation Sciences; Monash University; Clayton Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Victoria Australia
- Radiation Therapy Services; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
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Simon A, Nassef M, Rigaud B, Cazoulat G, Castelli J, Lafond C, Acosta O, Haigron P, de Crevoisier R. Roles of Deformable Image Registration in adaptive RT: From contour propagation to dose monitoring. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:5215-8. [PMID: 26737467 DOI: 10.1109/embc.2015.7319567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Adaptive radiation therapy (ART) is based on the optimization of the treatment plan during the treatment delivery to compensate for anatomical deformations. Deformable Image Registration (DIR) then constitutes a key step in order to analyze the huge amount of daily or weekly images to provide clinically usefull information. Two main applications of DIR have been developped in ART: delineation propagation and dose accumulation. If delineation propagation is well validated and transfered in the clinic, some challenges remain to address for dose accumulation. In this paper, we review the recent developments of DIR in ART, particularly in prostate and head-and-neck (H&N), with a focus on their evaluation.
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Vinod SK, Jameson MG, Min M, Holloway LC. Uncertainties in volume delineation in radiation oncology: A systematic review and recommendations for future studies. Radiother Oncol 2016; 121:169-179. [PMID: 27729166 DOI: 10.1016/j.radonc.2016.09.009] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/27/2016] [Accepted: 09/25/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Volume delineation is a well-recognised potential source of error in radiotherapy. Whilst it is important to quantify the degree of interobserver variability (IOV) in volume delineation, the resulting impact on dosimetry and clinical outcomes is a more relevant endpoint. We performed a literature review of studies evaluating IOV in target volume and organ-at-risk (OAR) delineation in order to analyse these with respect to the metrics used, reporting of dosimetric consequences, and use of statistical tests. METHODS AND MATERIALS Medline and Pubmed databases were queried for relevant articles using keywords. We included studies published in English between 2000 and 2014 with more than two observers. RESULTS 119 studies were identified covering all major tumour sites. CTV (n=47) and GTV (n=38) were most commonly contoured. Median number of participants and data sets were 7 (3-50) and 9 (1-132) respectively. There was considerable heterogeneity in the use of metrics and methods of analysis. Statistical analysis of results was reported in 68% (n=81) and dosimetric consequences in 21% (n=25) of studies. CONCLUSION There is a lack of consistency in conducting and reporting analyses from IOV studies. We suggest a framework to use for future studies evaluating IOV.
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Affiliation(s)
- Shalini K Vinod
- Cancer Therapy Centre, Liverpool Hospital, Australia; South Western Sydney Clinical School, University of New South Wales, Australia; Western Sydney University, Australia.
| | - Michael G Jameson
- Cancer Therapy Centre, Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research, Liverpool Hospital, Australia; Centre for Medical Radiation Physics, University of Wollongong, Australia
| | - Myo Min
- Cancer Therapy Centre, Liverpool Hospital, Australia; South Western Sydney Clinical School, University of New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool Hospital, Australia
| | - Lois C Holloway
- Cancer Therapy Centre, Liverpool Hospital, Australia; South Western Sydney Clinical School, University of New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool Hospital, Australia; Centre for Medical Radiation Physics, University of Wollongong, Australia
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Vinod SK, Min M, Jameson MG, Holloway LC. A review of interventions to reduce inter-observer variability in volume delineation in radiation oncology. J Med Imaging Radiat Oncol 2016; 60:393-406. [DOI: 10.1111/1754-9485.12462] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/16/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Shalini K Vinod
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Sydney Clinical School; University of NSW; Sydney New South Wales Australia
- Western Sydney University; Sydney New South Wales Australia
| | - Myo Min
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Sydney Clinical School; University of NSW; Sydney New South Wales Australia
| | - Michael G Jameson
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- Ingham Institute of Applied Medical Research; Liverpool Hospital; Liverpool New South Wales Australia
- Centre for Medical Radiation Physics; University of Wollongong; Wollongong New South Wales Australia
| | - Lois C Holloway
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Sydney Clinical School; University of NSW; Sydney New South Wales Australia
- Western Sydney University; Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research; Liverpool Hospital; Liverpool New South Wales Australia
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15
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Automated Delineation of the Normal Urinary Bladder on Planning CT and Cone Beam CT. J Med Imaging Radiat Sci 2016; 47:21-29. [DOI: 10.1016/j.jmir.2015.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 09/25/2015] [Accepted: 09/29/2015] [Indexed: 11/19/2022]
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Lutkenhaus LJ, Visser J, de Jong R, Hulshof MC, Bel A. Evaluation of delivered dose for a clinical daily adaptive plan selection strategy for bladder cancer radiotherapy. Radiother Oncol 2015; 116:51-6. [DOI: 10.1016/j.radonc.2015.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 06/01/2015] [Accepted: 06/04/2015] [Indexed: 11/25/2022]
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Scaife JE, Barnett GC, Noble DJ, Jena R, Thomas SJ, West CML, Burnet NG. Exploiting biological and physical determinants of radiotherapy toxicity to individualize treatment. Br J Radiol 2015; 88:20150172. [PMID: 26084351 PMCID: PMC4628540 DOI: 10.1259/bjr.20150172] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/07/2015] [Accepted: 05/21/2015] [Indexed: 12/16/2022] Open
Abstract
The recent advances in radiation delivery can improve tumour control probability (TCP) and reduce treatment-related toxicity. The use of intensity-modulated radiotherapy (IMRT) in particular can reduce normal tissue toxicity, an objective in its own right, and can allow safe dose escalation in selected cases. Ideally, IMRT should be combined with image guidance to verify the position of the target, since patients, target and organs at risk can move day to day. Daily image guidance scans can be used to identify the position of normal tissue structures and potentially to compute the daily delivered dose. Fundamentally, it is still the tolerance of the normal tissues that limits radiotherapy (RT) dose and therefore tumour control. However, the dose-response relationships for both tumour and normal tissues are relatively steep, meaning that small dose differences can translate into clinically relevant improvements. Differences exist between individuals in the severity of toxicity experienced for a given dose of RT. Some of this difference may be the result of differences between the planned dose and the accumulated dose (DA). However, some may be owing to intrinsic differences in radiosensitivity of the normal tissues between individuals. This field has been developing rapidly, with the demonstration of definite associations between genetic polymorphisms and variation in toxicity recently described. It might be possible to identify more resistant patients who would be suitable for dose escalation, as well as more sensitive patients for whom toxicity could be reduced or avoided. Daily differences in delivered dose have been investigated within the VoxTox research programme, using the rectum as an example organ at risk. In patients with prostate cancer receiving curative RT, considerable daily variation in rectal position and dose can be demonstrated, although the median position matches the planning scan well. Overall, in 10 patients, the mean difference between planned and accumulated rectal equivalent uniform doses was -2.7 Gy (5%), and a dose reduction was seen in 7 of the 10 cases. If dose escalation was performed to take rectal dose back to the planned level, this should increase the mean TCP (as biochemical progression-free survival) by 5%. Combining radiogenomics with individual estimates of DA might identify almost half of patients undergoing radical RT who might benefit from either dose escalation, suggesting improved tumour cure or reduced toxicity or both.
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Affiliation(s)
- J E Scaife
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - G C Barnett
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D J Noble
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - R Jena
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - S J Thomas
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Medical Physics Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C M L West
- Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, Manchester, UK
| | - N G Burnet
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
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Shaw SM, Flowers H, O'Sullivan B, Hope A, Liu LWC, Martino R. The effect of prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement on swallowing and swallow-related outcomes in patients undergoing radiotherapy for head and neck cancer: a systematic review. Dysphagia 2015; 30:152-75. [PMID: 25737196 DOI: 10.1007/s00455-014-9592-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/11/2014] [Indexed: 11/29/2022]
Abstract
Patients undergoing radiotherapy for head and neck cancer (HNC) often experience malnutrition and dehydration during treatment. As a result, some centres place PEG tubes prophylactically (pPEG) to prevent these negative consequences. However, recent research has suggested that pPEG use may negatively affect swallowing physiology, function and/or quality of life, especially in the long term. The purpose of this study was to systematically review the literature on pPEG use in HNC patients undergoing radiotherapy and to determine its impact on swallowing-related outcomes. The following electronic databases were searched for all relevant primary research published through February 24, 2014: AMED, CINAHL, the Cochrane Library, Embase, Healthstar, Medline, and PsycINFO. Main search terms included HNC, radiotherapy, deglutition disorders, feeding tube(s), and prophylactic or elective. References for all accepted papers were hand searched to identify additional relevant research. Methodological quality was assessed using Cochrane's Risk of Bias. At all levels, two blinded raters provided judgments. Discrepancies were resolved by consensus. The search retrieved 181 unique citations. Twenty studies met our inclusion criteria. Quality assessment revealed that all studies were at risk for bias due to non-randomized sampling and unreported or inadequate blinding. Ten studies demonstrated selection bias with significant baseline differences between pPEG patients and controls. Results regarding the frequency and severity of dysphagia and swallowing-related outcomes were varied and inconclusive. The impact of pPEG use on swallowing and swallowing-related outcomes remains unclear. Well-controlled, randomized trials are needed to determine if pPEG places patients at greater risk for developing long-term dysphagia.
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Affiliation(s)
- Stephanie M Shaw
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, 160-500 University Ave., Toronto, ON, M5G 1V7, Canada,
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Scaife J, Harrison K, Romanchikova M, Parker A, Sutcliffe M, Bond S, Thomas S, Freeman S, Jena R, Bates A, Burnet N. Random variation in rectal position during radiotherapy for prostate cancer is two to three times greater than that predicted from prostate motion. Br J Radiol 2014; 87:20140343. [PMID: 25138155 PMCID: PMC4170867 DOI: 10.1259/bjr.20140343] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: Radiotherapy for prostate cancer does not explicitly take into account daily variation in the position of the rectum. It is important to accurately assess accumulated dose (DA) to the rectum in order to understand the relationship between dose and toxicity. The primary objective of this work was to quantify systematic (Σ) and random (σ) variation in the position of the rectum during a course of prostate radiotherapy. Methods: The rectum was manually outlined on the kilo-voltage planning scan and 37 daily mega-voltage image guidance scans for 10 participants recruited to the VoxTox study. The femoral heads were used to produce a fixed point to which all rectal contours were referenced. Results: Σ [standard deviation (SD) of means] between planning and treatment was 4.2 mm in the anteroposterior (AP) direction and 1.3 mm left–right (LR). σ (root mean square of SDs) was 5.2 mm AP and 2.7 mm LR. Superior–inferior variation was less than one slice above and below the planning position. Conclusion: Our results for Σ are in line with published data for prostate motion. σ, however, was approximately twice as great as that seen for prostate motion. This suggests that DA may differ from planned dose in some patients treated with radiotherapy for prostate cancer. Advances in knowledge: This work is the first to use daily imaging to quantify Σ and σ of the rectum in prostate cancer. σ was found to be greater than published data, providing strong rationale for further investigation of individual DA.
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Affiliation(s)
- J Scaife
- 1 Department of Oncology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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Cazoulat G, Simon A, Dumenil A, Gnep K, De Crevoisier R, Acosta-Tamayo O, Haigron P. Surface-constrained nonrigid registration for dose monitoring in prostate cancer radiotherapy. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:1464-1474. [PMID: 24710827 PMCID: PMC5325876 DOI: 10.1109/tmi.2014.2314574] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This paper addresses the issue of cumulative dose estimation from cone beam computed tomography (CBCT) images in prostate cancer radiotherapy. It focuses on the dose received by the surfaces of the main organs at risk, namely the bladder and rectum. We have proposed both a surface-constrained dose accumulation approach and its extensive evaluation. Our approach relied on the nonrigid registration (NRR) of daily acquired CBCT images on the planning CT image. This proposed NRR method was based on a Demons-like algorithm, implemented in combination with mutual information metric. It allowed for different levels of geometrical constraints to be considered, ensuring a better point to point correspondence, especially when large deformations occurred, or in high dose gradient areas. The three following implementations: 1) full iconic NRR; 2) iconic NRR constrained with landmarks (LCNRR); 3) NRR constrained with full delineation of organs (DBNRR). To obtain reference data, we designed a numerical phantom based on finite-element modeling and image simulation. The methods were assessed on both the numerical phantom and real patient data in order to quantify uncertainties in terms of dose accumulation. The LCNRR method appeared to constitute a good compromise for dose monitoring in clinical practice.
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Affiliation(s)
- Guillaume Cazoulat
- LTSI, Laboratoire Traitement du Signal et de l'Image
Institut National de la Santé et de la Recherche Médicale - U1099Université de Rennes 1 - Campus Universitaire de Beaulieu - Bât 22 - 35042 Rennes
| | - Antoine Simon
- LTSI, Laboratoire Traitement du Signal et de l'Image
Institut National de la Santé et de la Recherche Médicale - U1099Université de Rennes 1 - Campus Universitaire de Beaulieu - Bât 22 - 35042 Rennes
| | - Aurelien Dumenil
- LTSI, Laboratoire Traitement du Signal et de l'Image
Institut National de la Santé et de la Recherche Médicale - U1099Université de Rennes 1 - Campus Universitaire de Beaulieu - Bât 22 - 35042 Rennes
| | - Khemara Gnep
- Centre Eugène Marquis
CRLCC Eugène Marquis - Avenue Bataille Flandres-Dunkerque 35042 RENNES CEDEX
| | - Renaud De Crevoisier
- LTSI, Laboratoire Traitement du Signal et de l'Image
Institut National de la Santé et de la Recherche Médicale - U1099Université de Rennes 1 - Campus Universitaire de Beaulieu - Bât 22 - 35042 Rennes
- Centre Eugène Marquis
CRLCC Eugène Marquis - Avenue Bataille Flandres-Dunkerque 35042 RENNES CEDEX
| | - Oascar Acosta-Tamayo
- LTSI, Laboratoire Traitement du Signal et de l'Image
Institut National de la Santé et de la Recherche Médicale - U1099Université de Rennes 1 - Campus Universitaire de Beaulieu - Bât 22 - 35042 Rennes
| | - Pascal Haigron
- LTSI, Laboratoire Traitement du Signal et de l'Image
Institut National de la Santé et de la Recherche Médicale - U1099Université de Rennes 1 - Campus Universitaire de Beaulieu - Bât 22 - 35042 Rennes
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van de Schoot AJAJ, Schooneveldt G, Wognum S, Hoogeman MS, Chai X, Stalpers LJA, Rasch CRN, Bel A. Generic method for automatic bladder segmentation on cone beam CT using a patient-specific bladder shape model. Med Phys 2014; 41:031707. [DOI: 10.1118/1.4865762] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nishioka K, Shimizu S, Kinoshita R, Inoue T, Onodera S, Yasuda K, Harada K, Nishikawa Y, Onimaru R, Shirato H. Evaluation of inter-observer variability of bladder boundary delineation on cone-beam CT. Radiat Oncol 2013; 8:185. [PMID: 23879876 PMCID: PMC3726473 DOI: 10.1186/1748-717x-8-185] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/21/2013] [Indexed: 11/23/2022] Open
Abstract
Background In-room cone-beam computerized tomography (CBCT) imaging is a promising method to reduce setup errors, especially in organs such as the bladder that often have large intrafractional variations due to organ movement. CBCT image quality is limited by low contrast and imaging artifacts, but few data have been reported about inter-observer variability of bladder boundary delineation on CBCT. The aim of this work was to analyze and evaluate the inter-observer contouring uncertainties of bladder boundary delineation on CBCT images in a prospective fashion. Methods Five radiation oncologists contoured 10 bladders using the CBCT datasets of consecutive 10 patients (including 4 females) who were irradiated to the pelvic region. Prostates were also contoured in male patients. Patients who had had prostatectomy were excluded. The coefficient of variation (COV), conformity index (CIgen), and coordinates of center-of-mass (COM) of the bladder and prostate were calculated for each patient. Results The mean COV for the bladder and prostate was 0.08 and 0.20, respectively. The mean CIgen of the bladder and prostate was 0.81 and 0.66, respectively. The root mean square (RMS) of the inter-observer standard deviation (σ) of the COM displacement in the left-right (LR) and anterior-posterior (AP) direction was 0.79, 0.87 and 0.54 for the bladder and 0.63, 0.99 and 1.72 for the prostate. Regarding the mean COV and CIgen for the bladder, the differences between males and females were not significant. Conclusions Inter-observer variability for bladder delineation on CBCT images was substantially small regardless of gender. We believe that our results support the applicability of CBCT in adaptive radiotherapy for bladder cancer.
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Affiliation(s)
- Kentaro Nishioka
- Department of Radiation Medicine, Hokkaido University School of Medicine, Sapporo, Japan
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Foroudi F, Pham D, Bressel M, Gill S, Kron T. Intrafraction Bladder Motion in Radiation Therapy Estimated From Pretreatment and Posttreatment Volumetric Imaging. Int J Radiat Oncol Biol Phys 2013; 86:77-82. [DOI: 10.1016/j.ijrobp.2012.11.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 11/22/2012] [Accepted: 11/27/2012] [Indexed: 11/30/2022]
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Webster GJ, Stratford J, Rodgers J, Livsey JE, Macintosh D, Choudhury A. Comparison of adaptive radiotherapy techniques for the treatment of bladder cancer. Br J Radiol 2013; 86:20120433. [PMID: 23255547 PMCID: PMC4651060 DOI: 10.1259/bjr.20120433] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 10/02/2012] [Accepted: 10/10/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Day-to-day anatomical variations complicate bladder cancer radiotherapy treatment. This work quantifies the impact on target coverage and irradiated normal tissue volume for different adaptive strategies. METHODS 20 patients were retrospectively planned using different three-dimensional conformal radiotherapy treatment strategies for whole-bladder carcinoma: (i) "conventional" treatment used isotropic expansion of the clinical target volume (CTV) by 15 mm to the planning target volume (PTV) for daily treatment; (ii) "plan of the day" used daily volumetric on-treatment imaging [cone beam CT (CBCT)] to select from four available plans with varying superior PTV margins; (iii) "composite" strategies used on-treatment CBCTs from Fractions 1-3 to inform a composite CTV and adapted PTV (5- and 10-mm margins for composite 1 and composite 2, respectively) for subsequent treatment. Target coverage was evaluated from available CBCTs (the first three fractions then the minimum weekly thereafter), and the reduction in the irradiated volume (i.e. within the 95% isodose) was quantified. RESULTS Plan of the day improved target coverage (i.e. all of the bladder within the 95% isodose throughout the treatment) relative to conventional treatment (p=0.10), while no such benefit was observed with composite 2. Target coverage was reduced with composite 1 relative to conventional treatment. The mean irradiated volume was reduced by 17.2%, 35.0% and 14.6% relative to conventional treatment, for plan of the day, composite 1 and composite 2, respectively (p<0.01 in all cases). No parameters predictive of large changes in bladder volume later in the treatment were identified. CONCLUSIONS Adaptive techniques can maintain or improve target coverage while allowing for reduced irradiated volume and possibly reduced toxicity. The plan-of-the-day technique appeared to provide the optimal balance between target coverage and normal tissue sparing. ADVANCES IN KNOWLEDGE This study suggests that plan-of-the-day techniques will provide optimal outcomes for adaptive bladder radiotherapy.
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Affiliation(s)
- G J Webster
- Christie Medical Physics & Engineering, Christie NHS Foundation Trust, Manchester, UK.
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Foroudi F, Pham D, Bressel M, Wong J, Rolfo A, Roxby P, Kron T. Bladder Cancer Radiotherapy Margins: A Comparison of Daily Alignment using Skin, Bone or Soft Tissue. Clin Oncol (R Coll Radiol) 2012; 24:673-81. [DOI: 10.1016/j.clon.2012.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 04/04/2012] [Accepted: 06/27/2012] [Indexed: 11/30/2022]
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Chai X, van Herk M, Betgen A, Hulshof M, Bel A. Semiautomatic bladder segmentation on CBCT using a population-based model for multiple-plan ART of bladder cancer. Phys Med Biol 2012. [DOI: 10.1088/0031-9155/57/24/n525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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27
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Rodrigues G, Louie A, Videtic G, Best L, Patil N, Hallock A, Gaede S, Kempe J, Battista J, de Haan P, Bauman G. Categorizing segmentation quality using a quantitative quality assurance algorithm. J Med Imaging Radiat Oncol 2012; 56:668-78. [DOI: 10.1111/j.1754-9485.2012.02442.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Accepted: 04/25/2012] [Indexed: 12/25/2022]
Affiliation(s)
- George Rodrigues
- Department of Radiation Oncology; University of Western Ontario and Lawson Health Research Institute; Canada
| | - Alexander Louie
- Department of Radiation Oncology; University of Western Ontario and Lawson Health Research Institute; Canada
| | - Gregory Videtic
- Department of Radiation Oncology; Cleveland Clinic; Cleveland; Ohio; USA
| | - Lara Best
- Department of Radiation Oncology; University of Western Ontario and Lawson Health Research Institute; Canada
| | - Nikhilesh Patil
- Department of Radiation Oncology; University of Western Ontario and Lawson Health Research Institute; Canada
| | - Abhirami Hallock
- Department of Radiation Oncology; University of Western Ontario and Lawson Health Research Institute; Canada
| | - Stewart Gaede
- Department of Medical Biophysics; University of Western Ontario; Canada
| | - Jeff Kempe
- Department of Physics and Engineering; London Regional Cancer Program; London Health Sciences Centre; London; Ontario; Canada
| | | | - Patricia de Haan
- Department of Radiation Oncology; VU University Medical Centre; Amsterdam; The Netherlands
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Kron T, Pham D, Roxby P, Rolfo A, Foroudi F. Credentialing of radiotherapy centres for a clinical trial of adaptive radiotherapy for bladder cancer (TROG 10.01). Radiother Oncol 2012; 103:293-8. [DOI: 10.1016/j.radonc.2012.03.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 02/12/2012] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
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Chai X, van Herk M, Betgen A, Hulshof M, Bel A. Automatic bladder segmentation on CBCT for multiple plan ART of bladder cancer using a patient-specific bladder model. Phys Med Biol 2012; 57:3945-62. [DOI: 10.1088/0031-9155/57/12/3945] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bissonnette JP, Balter PA, Dong L, Langen KM, Lovelock DM, Miften M, Moseley DJ, Pouliot J, Sonke JJ, Yoo S. Quality assurance for image-guided radiation therapy utilizing CT-based technologies: A report of the AAPM TG-179. Med Phys 2012; 39:1946-63. [PMID: 22482616 DOI: 10.1118/1.3690466] [Citation(s) in RCA: 198] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Foroudi F, Wong J, Kron T, Rolfo A, Haworth A, Roxby P, Thomas J, Herschtal A, Pham D, Williams S, Tai KH, Duchesne G. Online Adaptive Radiotherapy for Muscle-Invasive Bladder Cancer: Results of a Pilot Study. Int J Radiat Oncol Biol Phys 2011; 81:765-71. [DOI: 10.1016/j.ijrobp.2010.06.061] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 06/15/2010] [Accepted: 06/25/2010] [Indexed: 11/30/2022]
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Rosewall T, Bayley AJ, Chung P, Le LW, Xie J, Baxi S, Catton CN, Currie G, Wheat J, Milosevic M. The effect of delineation method and observer variability on bladder dose-volume histograms for prostate intensity modulated radiotherapy. Radiother Oncol 2011; 101:479-85. [PMID: 21864921 DOI: 10.1016/j.radonc.2011.06.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 06/17/2011] [Accepted: 06/18/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To quantify the effect of delineation method on bladder DVH, observer variability (OV) and contouring time for prostate IMRT plans. MATERIALS AND METHODS Planning CT scans and IMRT plans of 30 prostate cancer patients were anonymized. For 20 patients, 1 observer delineated the bladder using 9 methods. The effect of delineation method on the DVH curve, discrete dose levels and delineation time was quantified. For the 10 remaining CTs, 6 observers delineated bladder wall using 4 methods. Observer-based volume variation and intraclass correlation coefficient (ICC) were used to describe the dosimetric effects of OV. RESULTS Manual delineation of the bladder wall (BW_m) was significantly slower than any other method (mean: 20 min vs. ≤ 13 min) and the dosimetric effect of OV was significantly larger (V70 Gy ICC: 0.78 vs. 0.98). Only volumes created using a 2.5mm contraction from the outer surface, and a method providing a consistent wall volume, showed no notable dosimetric differences from BW_m in both absolute and relative volume. CONCLUSIONS Automatic contractions from the outer surface provide quicker, more reproducible and reasonably accurate substitutes for BW_m. The widespread use of automatic contractions to create a bladder wall volume would assist in the consistent application of IMRT dose constraints and the interpretation of reported dose.
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Affiliation(s)
- Tara Rosewall
- Princess Margaret Hospital and Department of Radiation Oncology, University of Toronto, Canada.
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Choi HJ, Kim YS, Lee SH, Lee YS, Park G, Jung JH, Cho BC, Park SH, Ahn H, Kim CS, Yi SY, Ahn SD. Inter- and intra-observer variability in contouring of the prostate gland on planning computed tomography and cone beam computed tomography. Acta Oncol 2011; 50:539-46. [PMID: 21391773 DOI: 10.3109/0284186x.2011.562916] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate inter-/intra-observer variability in defining the prostate by use of planning computed tomography (PCT) and cone beam CT (CBCT) with magnetic resonance image (MRI) as guidance prior to the introduction of an adaptive radiotherapy for prostate cancer. MATERIAL AND METHODS We reviewed PCT and firstly acquired CBCT datasets of each ten patients with prostate cancer. Three physicians independently delineated the prostate based on PCT and CBCT with MRI as guidance, allowing determination of inter-physician variability. Two physicians repeated prostate contouring three times in total to investigate intra-physician variability. We compared delineated prostate volumes in terms of the generalized conformity index (CI(gen)), maximum variation ratio (MVR), and center of mass (COM). RESULTS There were no significant inter-/intra-observer differences in the estimation of prostate volume on both PCT and CBCT. For both inter- and intra-observer variability in contouring the prostate gland, there were no significant differences in MVR between PCT and CBCT. The CI(gen) for inter-observer variability was 0.74 by PCT and 0.69 by CBCT. The CI(gen) for intra-observer variability on PCT and CBCT was 0.84 and 0.81 for observer 2 and 0.76 and 0.73 for observer 3. COM analyses showed that the greatest inter-/intra-observer variability was in the measurement of the prostate apex and base. With respect to CI(gen) and COM analysis for the inter-observer variability, more precise delineation of the prostate was possible on PCT than CBCT. More precise contouring in terms of both CI(gen) and COM was demonstrated by observer 2 than observer 3. CONCLUSIONS Despite some ambiguity in apex and base level, there was a good consistency in delineating the gland on CBCT plus MRI-guided modification both among/within observer(s), without any significant difference from the consistency in defining the prostate on PCT. This study provides a framework for future studies of CBCT imaging of the prostate.
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Affiliation(s)
- Hyuck Jae Choi
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
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Liszewski B, Choo E, D’Alimonte L. A Retrospective Analysis of Prostate Cone Beam Computed Tomography (CBCT) Image Registration: A Tale of Two Techniques. J Med Imaging Radiat Sci 2010; 41:207-214. [DOI: 10.1016/j.jmir.2010.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 10/06/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
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Button M, Staffurth J. Clinical Application of Image-guided Radiotherapy in Bladder and Prostate Cancer. Clin Oncol (R Coll Radiol) 2010; 22:698-706. [DOI: 10.1016/j.clon.2010.06.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 06/30/2010] [Indexed: 11/28/2022]
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