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Maniscalco A, Mathew E, Parsons D, Visak J, Arbab M, Alluri P, Li X, Wandrey N, Lin MH, Rahimi A, Jiang S, Nguyen D. Multimodal radiotherapy dose prediction using a multi-task deep learning model. Med Phys 2024; 51:3932-3949. [PMID: 38710210 PMCID: PMC11147699 DOI: 10.1002/mp.17115] [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: 12/09/2023] [Revised: 03/26/2024] [Accepted: 04/21/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND In radiation therapy (RT), accelerated partial breast irradiation (APBI) has emerged as an increasingly preferred treatment modality over conventional whole breast irradiation due to its targeted dose delivery and shorter course of treatment. APBI can be delivered through various modalities including Cobalt-60-based systems and linear accelerators with C-arm, O-ring, or robotic arm design. Each modality possesses distinct features, such as beam energy or the degrees of freedom in treatment planning, which influence their respective dose distributions. These modality-specific considerations emphasize the need for a quantitative approach in determining the optimal dose delivery modality on a patient-specific basis. However, manually generating treatment plans for each modality across every patient is time-consuming and clinically impractical. PURPOSE We aim to develop an efficient and personalized approach for determining the optimal RT modality for APBI by training predictive models using two different deep learning-based convolutional neural networks. The baseline network performs a single-task (ST), predicting dose for a single modality. Our proposed multi-task (MT) network, which is capable of leveraging shared information among different tasks, can concurrently predict dose distributions for various RT modalities. Utilizing patient-specific input data, such as a patient's computed tomography (CT) scan and treatment protocol dosimetric goals, the MT model predicts patient-specific dose distributions across all trained modalities. These dose distributions provide patients and clinicians quantitative insights, facilitating informed and personalized modality comparison prior to treatment planning. METHODS The dataset, comprising 28 APBI patients and their 92 treatment plans, was partitioned into training, validation, and test subsets. Eight patients were dedicated to the test subset, leaving 68 treatment plans across 20 patients to divide between the training and validation subsets. ST models were trained for each modality, and one MT model was trained to predict doses for all modalities simultaneously. Model performance was evaluated across the test dataset in terms of Mean Absolute Percent Error (MAPE). We conducted statistical analysis of model performance using the two-tailed Wilcoxon signed-rank test. RESULTS Training times for five ST models ranged from 255 to 430 min per modality, totaling 1925 min, while the MT model required 2384 min. MT model prediction required an average of 1.82 s per patient, compared to ST model predictions at 0.93 s per modality. The MT model yielded MAPE of 1.1033 ± 0.3627% as opposed to the collective MAPE of 1.2386 ± 0.3872% from ST models, and the differences were statistically significant (p = 0.0003, 95% confidence interval = [-0.0865, -0.0712]). CONCLUSION Our study highlights the potential benefits of a MT learning framework in predicting RT dose distributions across various modalities without notable compromises. This MT architecture approach offers several advantages, such as flexibility, scalability, and streamlined model management, making it an appealing solution for clinical deployment. With such a MT model, patients can make more informed treatment decisions, physicians gain more quantitative insight for pre-treatment decision-making, and clinics can better optimize resource allocation. With our proposed goal array and MT framework, we aim to expand this work to a site-agnostic dose prediction model, enhancing its generalizability and applicability.
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Affiliation(s)
- Austen Maniscalco
- Medical Artificial Intelligence and Automation Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ezek Mathew
- Medical Artificial Intelligence and Automation Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David Parsons
- Medical Artificial Intelligence and Automation Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Justin Visak
- Medical Artificial Intelligence and Automation Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mona Arbab
- Medical Artificial Intelligence and Automation Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Prasanna Alluri
- Medical Artificial Intelligence and Automation Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Xingzhe Li
- Medical Artificial Intelligence and Automation Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Narine Wandrey
- Medical Artificial Intelligence and Automation Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mu-Han Lin
- Medical Artificial Intelligence and Automation Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Asal Rahimi
- Medical Artificial Intelligence and Automation Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Steve Jiang
- Medical Artificial Intelligence and Automation Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dan Nguyen
- Medical Artificial Intelligence and Automation Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Yu CX. Radiotherapy of early‐stage breast cancer. PRECISION RADIATION ONCOLOGY 2023. [DOI: 10.1002/pro6.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Cedric X. Yu
- Radiation Oncology University of Maryland School of Medicine Baltimore Maryland USA
- Xcision Medical Systems Columbia Maryland USA
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Chen L, Becker SJ, McAvoy SA, Nichols EM, Guerrero M. Correlation of treatment time to target volume for GammaPod treatments: A simple second calculation. J Appl Clin Med Phys 2022; 23:e13524. [PMID: 35132771 PMCID: PMC8992953 DOI: 10.1002/acm2.13524] [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: 09/04/2021] [Revised: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The GammaPod is a novel device for stereotactic breast treatments that employs 25 rotating Co‐60 sources while the patient is continuously translated in three axes to deliver a highly conformal dose to the target. There is no commercial software available for independent second calculations. The purpose of this study is to determine an efficient way to estimate GammaPod treatment times based on target volume and use it as a second calculation for patient‐specific quality assurance. Methods Fifty‐nine GammaPod (Xcision Medical Systems, LLC.) breast cancer patient treatments were used as the fitting dataset for this study. Similar to the Curie‐seconds concept in brachytherapy, we considered dose‐rate × time/(prescribed dose) as a function of target volumes. Using a MATLAB (Mathworks, Natick, MA, USA) script, we generated linear (with 95% confidence interval (CI)) and quadratic fits and tested the resulting equations on an additional set of 30 patients. Results We found a strong correlation between the dose‐rate × time/(prescribed dose) and patients’ target volumes for both the linear and quadratic models. The linear fit was selected for use and using the polyval function in MATLAB, a 95% CI graph was created to depict the accuracy of the prediction for treatment times. Testing the model on 30 additional patients with target volumes ranging from 20 to 188 cc yielded treatment times from 10 to 25 min that in all cases were within the predicted CI. The average absolute difference between the predicted and actual treatment times was 1.0 min (range 0–3.3 min). The average percent difference was 5.8% (range 0%–18.4%). Conclusion This work has resulted in a viable independent calculation for GammaPod treatment times. This method has been implemented as a spreadsheet that is ready for clinical use to predict and verify the accuracy of breast cancer treatment times.
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Affiliation(s)
- Leah Chen
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA
| | - Stewart J Becker
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA
| | - Sarah Anne McAvoy
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA
| | - Elizabeth M Nichols
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA
| | - Mariana Guerrero
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA
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Yi B, Becker SJ. Simplified method for determining dose to a non-water phantom through the use of N D,w and IAEA TRS 483 for the GammaPod. Phys Med 2021; 88:138-141. [PMID: 34242885 DOI: 10.1016/j.ejmp.2021.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE GammaPod, a breast stereotactic radiosurgery device, utilizes 25 rotating Co-60 sources to deliver highly conformal dose distributions. The GammaPod system requires that reference dosimetry be performed in a specific vendor-supplied poly-methylmethacrylate (PMMA) phantom. The nonstandard nature of GammaPod dosimetry, in both the phantom material and machine-specific reference (msr), prohibits use of the American Association of Physicists in Medicine Task Group 51 (TG-51) protocol. This study proposes a practical method using TRS 483 to make the reference dosimetry procedure simpler and to reduce overall uncertainties. METHODS The dose to PMMA (DPMMA) is determined under msr conditions using TRS 483 with an Exradin A1SL chamber placed in a PMMA phantom. The conversion factor, which converts from the dose-to-water (Dw) in broad-beam Co-60 reference geometry to DPMMA in the msr small field Co-60 (Qmsr) geometry, is derived using the Monte Carlo simulations and procedure described in TRS 483. RESULTS The new conversion factor value for an Exradin A1SL chamber is 0.974. When combined with ND,w, DPMMA differs by 0.5% from the TG-21/Nx method and 0.2% from the IROC values. Uncertainty decreased from 2.2% to 1.6%. CONCLUSION We successfully implemented TRS 483 reference dosimetry protocols utilizing ND,w for the GammaPod in the PMMA phantom. These results show not only agreement between measurements performed with the previously published method and independent thermoluminescent dosimetry measurements but also reductions in uncertainty. This also provides readers with a pathway to develop their own IAEA TRS 483 factor for any new small field machine that may be developed.
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Affiliation(s)
- ByongYong Yi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Stewart J Becker
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Nichols EM, Guerrero M, McAvoy S, Biggins T, Yi B, Becker SJ. Workflow guide to delivering a safe breast treatment using a novel stereotactic radiation delivery system. JOURNAL OF RADIOSURGERY AND SBRT 2021; 7:249-252. [PMID: 33898089 PMCID: PMC8055237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Elizabeth M Nichols
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - Mariana Guerrero
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - Sarah McAvoy
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - Terri Biggins
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - ByongYong Yi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - Stewart J Becker
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
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Yukihara EG, Kron T. APPLICATIONS OF OPTICALLY STIMULATED LUMINESCENCE IN MEDICAL DOSIMETRY. RADIATION PROTECTION DOSIMETRY 2020; 192:122-138. [PMID: 33412585 DOI: 10.1093/rpd/ncaa213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 11/15/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
If the first decade of the new millennium saw the establishment of a more solid foundation for the use of the Optically Stimulated Luminescence (OSL) in medical dosimetry, the second decade saw the technique take root and become more widely used in clinical studies. Recent publications report not only characterization and feasibility studies of the OSL technique for various applications in radiotherapy and radiology, but also the practical use of OSL for postal audits, estimation of staff dose, in vivo dosimetry, dose verification and dose mapping studies. This review complements previous review papers and reports on the topic, providing a panorama of the new advances and applications in the last decade. Attention is also dedicated to potential future applications, such as LET dosimetry, 2D/3D dosimetry using OSL, dosimetry in magnetic resonance imaging-guided radiotherapy (MRIgRT) and dosimetry of extremely high dose rates (FLASH therapy).
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Affiliation(s)
- Eduardo G Yukihara
- Department of Radiation Safety and Security, Paul Scherrer Institute, 5200 Villigen, Switzerland
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, 3000 Melbourne, Australia
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Parsons D, Zhang Y, Gu X, Lu W. POD‐DOSI: A dedicated dosimetry system for GammaPod commissioning and quality assurance. Med Phys 2020; 47:3647-3657. [DOI: 10.1002/mp.14221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- David Parsons
- Department of Radiation Oncology University of Texas Southwestern Medical Center 2280 Inwood Rd. Dallas TX 75390 USA
| | - You Zhang
- Department of Radiation Oncology University of Texas Southwestern Medical Center 2280 Inwood Rd. Dallas TX 75390 USA
| | - Xuejun Gu
- Department of Radiation Oncology University of Texas Southwestern Medical Center 2280 Inwood Rd. Dallas TX 75390 USA
| | - Weiguo Lu
- Department of Radiation Oncology University of Texas Southwestern Medical Center 2280 Inwood Rd. Dallas TX 75390 USA
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Kopchick B, Xu H, Niu Y, Becker S, Qiu X, Yu C. Technical Note: Dosimetric feasibility of lattice radiotherapy for breast cancer using GammaPod. Med Phys 2020; 47:3928-3934. [PMID: 32640039 DOI: 10.1002/mp.14379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/06/2020] [Accepted: 06/10/2020] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Studies on Lattice radiotherapy (LRT) for breast cancer have been largely lacking. This study investigates the dosimetric feasibility of using Gamma Pod, a stereotactic radiotherapy apparatus originally designed for breast SBRT, to deliver LRT to large, bulky breast tumor as a noninvasive treatment option. METHODS The GammaPod-based LRT was simulated using Geant4 Gate Monte Carlo software. The simulated GammaPod was equipped with 5 mm diameter non-coplanar circular beams that span 28° latitudinally from 18° to 43° off the horizontal plane. Two degrees longitudinal intervals were used to simulate rotating sources. To simulate the treatments to different breast sizes, three water-equivalent hemisphere volumes with diameters of 10, 15, and 20 cm were analyzed. The lattice was planned by spacing focal points 2 cm apart in the transverse and sagittal planes and 2.5 cm in the coronal plane. This resulted in 22-172 shots for full breast treatment. The maximum dose for each individual shot was 20 Gy. The peak-to-valley dose differences and skin dose were analyzed. To verify the feasibility of delivering LRT, a test plan was created and delivered to a commercial diode array dose verification device using a clinical GammaPod system with 15 mm collimators. RESULTS The dose profiles showed the average peak-to-valley dose percent differences of 94.10% in the 10 cm hemispherical volume, 88.95% in the 15 cm hemispherical volume, and 83.60% in the 20 cm hemispherical volume. Average skin dose was 1.27, 1.72, and 2.13 Gy for the 10, 15, and 20 cm irradiation volumes, respectively. The LRT plan delivered using a clinical GammaPod system with larger collimators verified the feasibility of LRT plan delivery. CONCLUSION GammaPod-based lattice radiotherapy is a viable treatment option and its application can be extended to treating large bulky breast tumors.
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Affiliation(s)
| | - Huijun Xu
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Ying Niu
- Xcision Medical Systems, Columbia, MD, 21045, USA
| | - Stewart Becker
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Xiangyun Qiu
- The George Washington University, Washington, DC, 20052, USA
| | - Cedric Yu
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Xcision Medical Systems, Columbia, MD, 21045, USA
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Becker SJ, Culberson WS, Poirier Y, Mutaf Y, Niu Y, Nichols EM, Yi B. Dosimetry evaluation of the GammaPod stereotactic radiosurgery device based on established AAPM and IAEA protocols. Med Phys 2020; 47:3614-3620. [DOI: 10.1002/mp.14197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Stewart J. Becker
- Department of Radiation Oncology University of Maryland School of Medicine Baltimore MD 21201 USA
| | - Wesley S. Culberson
- Department of Medical Physics University of Wisconsin–Madison Madison Wisconsin 53705 USA
| | - Yannick Poirier
- Department of Radiation Oncology University of Maryland School of Medicine Baltimore MD 21201 USA
| | - Yildirim Mutaf
- Department of Radiation Oncology University of Maryland School of Medicine Baltimore MD 21201 USA
| | - Ying Niu
- MedStar Georgetown University Hospital Washington DC 20007 USA
| | - Elizabeth M. Nichols
- Department of Radiation Oncology University of Maryland School of Medicine Baltimore MD 21201 USA
| | - Byongyong Yi
- Department of Radiation Oncology University of Maryland School of Medicine Baltimore MD 21201 USA
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Becker SJ, Niu Y, Mutaf Y, Chen S, Poirier Y, Nichols EM, Yi B. Development and validation of a comprehensive patient-specific quality assurance program for a novel stereotactic radiation delivery system for breast lesions. J Appl Clin Med Phys 2019; 20:138-148. [PMID: 31833640 PMCID: PMC6909122 DOI: 10.1002/acm2.12778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The GammaPod is a dedicated prone breast stereotactic radiosurgery (SRS) machine composed of 25 cobalt-60 sources which rotate around the breast to create highly conformal dose distributions for boosts, partial-breast irradiation, or neo-adjuvant SRS. We describe the development and validation of a patient-specific quality assurance (PSQA) system for the GammaPod. METHODS We present two PSQA methods: measurement based and calculation based PSQA. The measurements are performed with a combination of absolute and relative dose measurements. Absolute dosimetry is performed in a single point using a 0.053-cc pinpoint ionization chamber in the center of a polymethylmethacrylate (PMMA) breast phantom and a water-filled breast cup. Relative dose distributions are verified with EBT3 film in the PMMA phantom. The calculation-based method verifies point doses with a novel semi-empirical independent-calculation software. RESULTS The average (± standard deviation) breast and target sizes were 1263 ± 335.3 cc and 66.9 ± 29.9 cc, respectively. All ion chamber measurements performed in water and the PMMA phantom agreed with the treatment planning system (TPS) within 2.7%, with average (max) difference of -1.3% (-1.9%) and -1.3% (-2.7%), respectively. Relative dose distributions measured by film showed an average gamma pass rate of 97.0 ± 3.2 when using a 3%/1 mm criteria. The lowest gamma analysis pass rate was 90.0%. The independent calculation software had average agreements (max) with the patient and QA plan calculation of 0.2% (2.2%) and -0.1% (2.0%), respectively. CONCLUSION We successfully implemented the first GammaPod PSQA program. These results show that the GammaPod can be used to calculate and deliver the predicted dose precisely and accurately. For routine PSQA performed prior to treatments, the independent calculation is recommended as it verifies the accuracy of the planned dose without increasing the risk of losing vacuum due to prolonged waiting times.
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Affiliation(s)
- Stewart J. Becker
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Ying Niu
- MedStar Georgetown University HospitalWashingtonDCUSA
| | - Yildirim Mutaf
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Shifeng Chen
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Yannick Poirier
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Elizabeth M. Nichols
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - ByongYong Yi
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
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Becker S, Sabouri P, Niu Y, Prado K, Chen S, Nichols E, Yi B. Commissioning and acceptance guide for the GammaPod. ACTA ACUST UNITED AC 2019; 64:205021. [DOI: 10.1088/1361-6560/ab41bd] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Cuaron JJ, MacDonald SM, Cahlon O. Novel applications of proton therapy in breast carcinoma. Chin Clin Oncol 2017; 5:52. [PMID: 27558253 DOI: 10.21037/cco.2016.06.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/28/2016] [Indexed: 12/18/2022]
Abstract
This review will focus on the indications, clinical experience, and technical considerations of proton beam radiation therapy in the treatment of patients with breast cancer. For patients with early stage disease, proton therapy delivers less dose to non-target breast tissue for patients receiving partial breast irradiation (PBI) therapy, which may result in improved cosmesis but requires further investigation. For patients with locally advanced breast cancer requiring treatment to the regional lymph nodes, proton therapy allows for an improved dosimetric profile compared with conventional photon and electron techniques. Early clinical results demonstrate acceptable toxicity. The possible reduction in cardiopulmonary events as a result of reduced dose to organs at risk will be tested in a randomized control trial of protons vs. photons.
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Affiliation(s)
- John J Cuaron
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Shannon M MacDonald
- Massachusetts General Hospital, Francis H. Burr Proton Therapy Center, Boston, MA 02114-7250, USA
| | - Oren Cahlon
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Ahmed MF, Shrestha N, Schnell E, Ahmad S, Akselrod MS, Yukihara EG. Characterization of Al2O3optically stimulated luminescence films for 2D dosimetry using a 6 MV photon beam. Phys Med Biol 2016; 61:7551-7570. [DOI: 10.1088/0031-9155/61/21/7551] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ödén J, Toma-Dasu I, Yu CX, Feigenberg SJ, Regine WF, Mutaf YD. Dosimetric comparison between intra-cavitary breast brachytherapy techniques for accelerated partial breast irradiation and a novel stereotactic radiotherapy device for breast cancer: GammaPod™. Phys Med Biol 2013; 58:4409-21. [PMID: 23743718 DOI: 10.1088/0031-9155/58/13/4409] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The GammaPod™ device, manufactured by Xcision Medical Systems, is a novel stereotactic breast irradiation device. It consists of a hemispherical source carrier containing 36 Cobalt-60 sources, a tungsten collimator with two built-in collimation sizes, a dynamically controlled patient support table and a breast immobilization cup also functioning as the stereotactic frame for the patient. The dosimetric output of the GammaPod™ was modelled using a Monte Carlo based treatment planning system. For the comparison, three-dimensional (3D) models of commonly used intra-cavitary breast brachytherapy techniques utilizing single lumen and multi-lumen balloon as well as peripheral catheter multi-lumen implant devices were created and corresponding 3D dose calculations were performed using the American Association of Physicists in Medicine Task Group-43 formalism. Dose distributions for clinically relevant target volumes were optimized using dosimetric goals set forth in the National Surgical Adjuvant Breast and Bowel Project Protocol B-39. For clinical scenarios assuming similar target sizes and proximity to critical organs, dose coverage, dose fall-off profiles beyond the target and skin doses at given distances beyond the target were calculated for GammaPod™ and compared with the doses achievable by the brachytherapy techniques. The dosimetric goals within the protocol guidelines were fulfilled for all target sizes and irradiation techniques. For central targets, at small distances from the target edge (up to approximately 1 cm) the brachytherapy techniques generally have a steeper dose fall-off gradient compared to GammaPod™ and at longer distances (more than about 1 cm) the relation is generally observed to be opposite. For targets close to the skin, the relative skin doses were considerably lower for GammaPod™ than for any of the brachytherapy techniques. In conclusion, GammaPod™ allows adequate and more uniform dose coverage to centrally and peripherally located targets with an acceptable dose fall-off and lower relative skin dose than the brachytherapy techniques considered in this study.
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Affiliation(s)
- Jakob Ödén
- Department of Medical Physics, Karolinska University Hospital, Stockholm, Sweden.
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