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Lastrucci A, Morelli I, Votta C, Maran I, Iosca N, Monaco IP, Salvestrini V, Desideri I, Marrazzo L, Wandael Y, Cornacchione P, Pallotta S, Giansanti D, Ricci R, Livi L, Bonomo P. Open-Face Masks in Radiotherapy: Enhancing Therapeutic Strategies for Head and Neck and Brain Cancer Patients-A Comprehensive Scoping Review. Cancers (Basel) 2024; 16:2899. [PMID: 39199669 PMCID: PMC11353183 DOI: 10.3390/cancers16162899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/14/2024] [Accepted: 08/19/2024] [Indexed: 09/01/2024] Open
Abstract
Introduction: The main goal of radiotherapy (RT) is to deliver a precise dose to the target while sparing the surrounding normal tissue and minimizing side effects. Appropriate patient immobilization is crucial, especially for head and neck cancer (HNC) and Brain Cancer (BC). Conventional closed-face masks (CFMs), while effective in minimizing head motion, can cause significant discomfort, anxiety, and claustrophobia. Open-face masks (OFMs) have been developed to increase patient comfort while providing precise immobilization. Methods: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) extension for scoping reviews and the Arskey and O'Malley framework, an electronic search of EMBASE, PubMed, SCOPUS, and Web of Science was conducted to identify original studies reporting the use and description of OFMs in clinical practice up to April 2024. The inclusion criteria were English-language articles focusing on OFMs for HNC and BC patients undergoing RT. Results: Of 618 titles, 19 articles fulfilled the selection criteria. Most studies were comparative (n = 13) or observational (n = 6). The articles were categorized by treatment site, resulting in three groups: BC (n = 14, 68.4%), HNC (n = 4, 21.4%), and mixed (n = 2, 10.5%), which includes both BC and HNC. Of note, 82.4% (n = 16) of the included studies were published from 2020 onwards, emphasizing the recent adoption of OFM in clinical practice. Conclusions: The reviewed studies show that OFMs, in combination with SGRT, offer significant advantages in terms of patient comfort and positioning accuracy in HNC and BC treatments. Reproducibility in the sub-millimeter and sub-degree range can be achieved, which supports the use of OFMs in clinical practice. Future research should explore innovative combinations of immobilization and monitoring to further improve RT outcomes and ensure precise treatment while increasing patient comfort.
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Affiliation(s)
- Andrea Lastrucci
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Ilaria Morelli
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, 50134 Florence, Italy (L.M.)
| | - Claudio Votta
- Dipartimento Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Irene Maran
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Nicola Iosca
- Radiation Oncology, Department of Diagnostic Pathology, Bioimages and Public Health, Azienda Ospedaliero-Universitaria Consorziale Policlinico, 70120 Bari, Italy
| | - Ilaria Pia Monaco
- Radiation Oncology, Department of Diagnostic Pathology, Bioimages and Public Health, Azienda Ospedaliero-Universitaria Consorziale Policlinico, 70120 Bari, Italy
| | - Viola Salvestrini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, 50134 Florence, Italy (L.M.)
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Livia Marrazzo
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, 50134 Florence, Italy (L.M.)
- Medical Physics Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Yannick Wandael
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Patrizia Cornacchione
- Dipartimento Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Stefania Pallotta
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, 50134 Florence, Italy (L.M.)
- Medical Physics Unit, Careggi University Hospital, 50134 Florence, Italy
| | | | - Renzo Ricci
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, 50134 Florence, Italy (L.M.)
| | - Pierluigi Bonomo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
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Robinson A. Letter to the Editor: reply to "Comparison of patient setup accuracy for optical surface-guided and X-ray-guided imaging with respect to the impact on intracranial stereotactic radiotherapy". Strahlenther Onkol 2024; 200:642-643. [PMID: 38578508 PMCID: PMC11186858 DOI: 10.1007/s00066-024-02223-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/25/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Adi Robinson
- Department of Radiation Oncology, AdventHealth Celebration, 380 Celebration Place Suite 100, 34747, Celebration, FL, USA.
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Chen X, Liu L, Wang Y, Huang X, Cai W, Rong X, Lin L, Liu J, Jiang X. Surface guided radiation therapy with an innovative open-face mask and mouth bite: patient motion management in brain stereotactic radiotherapy. Clin Transl Oncol 2024; 26:424-433. [PMID: 37395988 DOI: 10.1007/s12094-023-03260-z] [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: 03/30/2023] [Accepted: 06/18/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION To guarantee treatment reproducibility and stability, immobilization devices are essential. Additionally, surface-guided radiation therapy (SGRT) serves as an accurate complement to frameless stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) by aiding patient positioning and real-time monitoring, especially when non-coplanar fields are in use. At our institute, we have developed a surface-guided SRS (SG-SRS) workflow that incorporates our innovative open-face mask (OM) and mouth bite (MB) to guarantee a precise and accurate dose delivery. METHODS This study included 40 patients, and all patients were divided into closed mask (CM) and open-face mask (OM) groups according to different positioning flow. Cone beam computed tomography (CBCT) scans were performed, and the registration results were recorded before and after the treatment. Then Bland-Altman method was used to analyze the consistency of AlignRT-guided positioning errors and CBCT scanning results in the OM group. The error changes between 31 fractions in one patient were recorded to evaluate the feasibility of monitoring during treatment. RESULTS The median of translation error between stages of the AlignRT positioning process was (0.03-0.07) cm, and the median of rotation error was (0.20-0.40)°, which were significantly better than those of the Fraxion positioning process (0.09-0.11) cm and (0.60-0.75)°. The mean bias values between the AlignRT guided positioning errors and CBCT were 0.01 cm, - 0.07 cm, 0.03 cm, - 0.30°, - 0.08° and 0.00°. The 31 inter-fractional errors of a single patient monitored by SGRT were within 0.10 cm and 0.50°. CONCLUSIONS The application of the SGRT with an innovative open-face mask and mouth bite device could achieve precision positioning accuracy and stability, and the accuracy of the AlignRT system exhibits excellent constancy with the CBCT gold standard. The non-coplanar radiation field monitoring can provide reliable support for motion management in fractional treatment.
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Affiliation(s)
- Xuemei Chen
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lu Liu
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yajuan Wang
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaotong Huang
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Weixun Cai
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaodong Rong
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Liuwen Lin
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jindi Liu
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Xiaobo Jiang
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.
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Li G, Yu V, Ryan K, Gil M, Biancia CD. Feasibility of a Novel Surface-Guided Setup Technique to Reproduce Neck Curvature Using two Regions of Interest. Technol Cancer Res Treat 2024; 23:15330338241271946. [PMID: 39109645 PMCID: PMC11307372 DOI: 10.1177/15330338241271946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/15/2024] [Accepted: 06/28/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE To improve the setup reproducibility of neck curvature using real-time optical surface imaging (OSI) guidance on 2 regions of interest (ROIs) to infer cervical spine (c-spine) curvature for surface-guided radiotherapy (SGRT) of head-and-neck (HN) and c-spine cancer. METHODS A novel SGRT setup approach was designed to reproduce neck curvature with 2 ROIs: upper-chest ROI and open-face ROI. It was hypothesized that the neck curvature could be reproduced if both ROIs were aligned within ±3 mm/2˚ tolerance. This was tested prospectively in 7 volunteers using real-time 3D-OSI guidance and lateral 2D-photography verification after the 3D and 2D references were captured from the initial conventional setup. Real-time SGRT was performed to align chest-ROI and face-ROI, and the longitudinal distance between them was adjustable using a head-support slider. Verification of neck curvature anteriorly and posteriorly was achieved by overlaying edge-extracted lateral pictures. Retrospectively, the relationship between anterior surface and spinal canal alignment was checked in 11 patients using their simulation CT (simCT) and setup cone-beam CT (CBCT). After the anterior surface was rigidly aligned, the spinal canal alignment was checked and quantified using the mean-distance-to-agreement (MDA) and DICE similarity index, and surface-to-spine correlation was calculated. RESULTS The reproducibility of neck curvatures using the 2xROI SGRT setup is verified and the mean neck-outline-matching difference is within ±2 mm in lateral photographic overlays. The chest-ROI alignment takes 110 ± 58 s and the face-ROI takes 60 ± 35 s. When the anterior body surface is aligned (MDA = 1.1 ± 0.6 mm, DICE = 0.96 ± 0.02,) the internal spinal canal is also aligned (MDA = 1.0 ± 0.3 mm, DICE = 0.84 ± 0.04) in 11 patients. The surface-to-spine correlation is c = 0.90 (MDA) and c = 0.85 (DICE). CONCLUSION This study demonstrates the feasibility of the novel 2-ROI SGRT setup technique to achieve reproducible neck and c-spine curvature regardless of neck visibility and availability as ROI. Staff training is needed to adopt this unconventional SGRT technique to improve patient setup.
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Affiliation(s)
- Guang Li
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victoria Yu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaitlyn Ryan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary Gil
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cesar Della Biancia
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Ben Bouchta Y, Gardner M, Sengupta C, Johnson J, Keall P. The Remove-the-Mask Open-Source head and neck Surface-Guided radiation therapy system. Phys Imaging Radiat Oncol 2024; 29:100541. [PMID: 38327762 PMCID: PMC10847032 DOI: 10.1016/j.phro.2024.100541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/22/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
Background and Purpose Surface Guided Radiotherapy (SGRT) for head and neck radiotherapy is challenging as obstructions are common and non-rigid facial motion can compromise surface accuracy. The purpose of this work was to develop and benchmark the Remove the Mask (RtM) SGRT system, an open-source system especially designed to address the challenges faced in radiotherapy of head and neck cancer. Materials and Methods The accuracy of the RtM SGRT system was benchmarked using a head phantom positioned on a robotic motion platform capable of sub-millimetre accuracy which was used to induce unidirectional shifts and to reproduce three real head motion traces. We also assessed the accuracy of the system in ten humans volunteers. The ground truth motion of the volunteers was obtained using a commercial motion capture system with an accuracy < 0.3 mm. Results The mean tracking error of the RtM SGRT system for the ten volunteers was of -0.1 ± 0.4 mm -0.6 ± 0.6 mm and 0.3 ± 0.2 mm, and 0.0 ± 0.2° 0.0 ± 0.1° and 0.0 ± 0.2° for translations and rotations along the left-right, superior-inferior and anterior-posterior axes respectively and we also found similar results in measurements with the head phantom. Forced facial motion was associated with lower tracking accuracy. The RtM SGRT system achieved submillimetre accuracy. Conclusion The RtM SGRT system is a low-cost, easy to build and open-source SGRT system that can achieve an accuracy that meets international commissioning guidelines. Its open-source and modular design allows for the development and easy translation of novel surface tracking techniques.
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Affiliation(s)
| | - Mark Gardner
- The University of Sydney, Camperdown, NSW 2050, Australia
| | | | - Julia Johnson
- The University of Sydney, Camperdown, NSW 2050, Australia
| | - Paul Keall
- The University of Sydney, Camperdown, NSW 2050, Australia
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Nguyen D, Khodri M, Sporea C, Reinoso R, Jacob Y, Farah J. Investigating the robustness of the AlignRT InBore™ co-calibration process and determining the overall tracking errors. Phys Med 2023; 108:102567. [PMID: 36996575 DOI: 10.1016/j.ejmp.2023.102567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/05/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE To determine the overall tracking errors inherent to the co-calibration procedure of AlignRT InBore™'s (Vision RT Ltd., London, UK) ceiling-mounted and ring-mounted cameras. METHODS Extrinsic calibration errors related to the mismatch between ceiling and InBore cameras' isocentres and treatment isocentre were determined using MV images and the SRS package and compared to traditional plate-based error. Next, using a realistic anthropomorphic female phantom, intrinsic calibration errors were determined while varying source-skin distance (80 to 100 cm), breast board inclination (0° to 12.5°), room lighting conditions (0 to 258 lx), skin colour (dark, white and natural skin colour), and pod occlusion. RESULTS MV images of the cube proved plate-based calibration to suffer from large errors especially in the vertical direction (up to 2 mm). Intrinsic calibration errors were considerably lower. Indeed, RTD values of ceiling and InBore cameras showed little variability with isocentre depth (within 1.0 mm/0.4°), surface orientation and breast board inclination (within 0.7 mm/0.3°), changing lighting conditions (within 0.1 mm/0.2°), skin colour/tone (within 0.3 mm/0.3°) and camera pod occlusion (within 0.3 mm/0.2°). CONCLUSION The use of MV-images proved critical to maintain co-calibrating errors of ceiling and InBore cameras to Halcyon's treatment isocentre below 1 mm.
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Li G. Advances and potential of optical surface imaging in radiotherapy. Phys Med Biol 2022; 67:10.1088/1361-6560/ac838f. [PMID: 35868290 PMCID: PMC10958463 DOI: 10.1088/1361-6560/ac838f] [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: 12/08/2021] [Accepted: 07/22/2022] [Indexed: 11/12/2022]
Abstract
This article reviews the recent advancements and future potential of optical surface imaging (OSI) in clinical applications as a four-dimensional (4D) imaging modality for surface-guided radiotherapy (SGRT), including OSI systems, clinical SGRT applications, and OSI-based clinical research. The OSI is a non-ionizing radiation imaging modality, offering real-time 3D surface imaging with a large field of view (FOV), suitable for in-room interactive patient setup, and real-time motion monitoring at any couch rotation during radiotherapy. So far, most clinical SGRT applications have focused on treating superficial breast cancer or deep-seated brain cancer in rigid anatomy, because the skin surface can serve as tumor surrogates in these two clinical scenarios, and the procedures for breast treatments in free-breathing (FB) or at deep-inspiration breath-hold (DIBH), and for cranial stereotactic radiosurgery (SRS) and radiotherapy (SRT) are well developed. When using the skin surface as a body-position surrogate, SGRT promises to replace the traditional tattoo/laser-based setup. However, this requires new SGRT procedures for all anatomical sites and new workflows from treatment simulation to delivery. SGRT studies in other anatomical sites have shown slightly higher accuracy and better performance than a tattoo/laser-based setup. In addition, radiographical image-guided radiotherapy (IGRT) is still necessary, especially for stereotactic body radiotherapy (SBRT). To go beyond the external body surface and infer an internal tumor motion, recent studies have shown the clinical potential of OSI-based spirometry to measure dynamic tidal volume as a tumor motion surrogate, and Cherenkov surface imaging to guide and assess treatment delivery. As OSI provides complete datasets of body position, deformation, and motion, it offers an opportunity to replace fiducial-based optical tracking systems. After all, SGRT has great potential for further clinical applications. In this review, OSI technology, applications, and potential are discussed since its first introduction to radiotherapy in 2005, including technical characterization, different commercial systems, and major clinical applications, including conventional SGRT on top of tattoo/laser-based alignment and new SGRT techniques attempting to replace tattoo/laser-based setup. The clinical research for OSI-based tumor tracking is reviewed, including OSI-based spirometry and OSI-guided tumor tracking models. Ongoing clinical research has created more SGRT opportunities for clinical applications beyond the current scope.
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Affiliation(s)
- Guang Li
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States of America
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Bry V, Saenz D, Pappas E, Kalaitzakis G, Papanikolaou N, Rasmussen K. End to end comparison of surface-guided imaging versus stereoscopic X-rays for the SRS treatment of multiple metastases with a single isocenter using 3D anthropomorphic gel phantoms. J Appl Clin Med Phys 2022; 23:e13576. [PMID: 35322526 PMCID: PMC9121024 DOI: 10.1002/acm2.13576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/10/2022] [Accepted: 02/12/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Two end-to-end tests evaluate the accuracy of a surface-guided radiation therapy (SGRT) system (CRAD Catalyst HD) for position verification in comparison to a stereoscopic x-ray imaging system (Brainlab Exactrac ) for single-isocenter, multiple metastases stereotactic radiosurgery (SRS) using 3D polymer gel inserts. MATERIALS AND METHODS A 3D-printed phantom (Prime phantom, RTsafe PC, Athens, Greece) with two separate cylindrical polymer gel inserts were immobilized in open-face masks and treated with a single isocentric, multitarget SRS plan. Planning was done in Brainlab (Elements) to treat five metastatic lesions in one fraction, and initial setup was done using cone beam computed tomography. Positional verification was done using orthogonal X-ray imaging (Brainlab Exactrac) and/or a surface imaging system (CRAD Catalyst HD, Uppsala, Sweden), and shift discrepancies were recorded for each couch angle. Forty-two hours after irradiation, the gel phantom was scanned in a 1.5 Tesla MRI, and images were fused with the patient computed tomography data/structure set for further analysis of spatial dose distribution. RESULTS Discrepancies between the CRAD Catalyst HD system and Brainlab Exactrac were <1 mm in the translational direction and <0.5° in the angular direction at noncoplanar couch angles. Dose parameters (DMean% , D95% ) and 3D gamma index passing rates were evaluated for both setup modalities for each planned target volume (PTV) at a variety of thresholds: 3%/2 mm (Exactrac≥93.1% and CRAD ≥87.2%), 5%/2 mm (Exactrac≥95.6% and CRAD ≥94.6%), and 5%/1 mm (Exactrac≥81.8% and CRAD ≥83.7%). CONCLUSION Dose metrics for a setup with surface imaging was found to be consistent with setup using x-ray imaging, demonstrating high accuracy and reproducibility for treatment delivery. Results indicate the feasibility of using surface imaging for position verification at noncoplanar couch angles for single-isocenter, multiple-target SRS using end-to-end quality assurance (QA) testing with 3D polymer gel dosimetry.
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Affiliation(s)
- Victoria Bry
- Department of Radiation OncologyThe University of Texas Health at San AntonioSan AntonioTexasUSA
| | - Daniel Saenz
- Department of Radiation OncologyThe University of Texas Health at San AntonioSan AntonioTexasUSA
| | - Evangelos Pappas
- Department of Biomedical SciencesRadiology and Radiotherapy SectorUniversity of West AtticaAthensGreece
| | | | - Nikos Papanikolaou
- Department of Radiation OncologyThe University of Texas Health at San AntonioSan AntonioTexasUSA
| | - Karl Rasmussen
- Department of Radiation OncologyThe University of Texas Health at San AntonioSan AntonioTexasUSA
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Han C, Amini A, Wong JYC, Liang J, Qing K, Watkins WT, Zhang S, Williams TM, Liu A. Comparison of intrafractional motion with two frameless immobilization systems in surface-guided intracranial stereotactic radiosurgery. J Appl Clin Med Phys 2022; 23:e13613. [PMID: 35441441 PMCID: PMC9195026 DOI: 10.1002/acm2.13613] [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: 12/20/2021] [Revised: 03/12/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose/objectives The aim of this study is to compare intrafractional motion using two commercial non‐invasive immobilization systems for linac‐based intracranial stereotactic radiosurgery (SRS) under guidance with a surface‐guided radiotherapy (SGRT) system. Materials/methods Twenty‐one patients who received intracranial SRS were retrospectively selected. Ten patients were immobilized with a vacuum fixation biteplate system, while 11 patients were immobilized with an open‐face mask system. A setup margin of 1 mm was used in treatment planning. Real‐time surface motion data in 37 treatment fractions using the vacuum fixation system and 44 fractions using the open‐face mask were recorded by an SGRT system. Variances of intrafractional motion along three translational directions and three rotational directions were compared between the two immobilization techniques with Levene's tests. Intrafractional motion variation over time during treatments was also evaluated. Results Using the vacuum fixation system, the average and standard deviations of the shifts were 0.01 ± 0.18 mm, ‐0.06 ± 0.30 mm, and 0.02 ± 0.26 mm in the anterior–posterior (AP), superior–inferior (SI), and left–right (LR) directions, and ‐0.02 ± 0.19°, ‐0.01 ± 0.13°, and 0.01 ± 0.13° for rotations in yaw, roll, and pitch, respectively; using the open‐face mask system, the average and standard deviations of the shifts were ‐0.06 ± 0.20 mm, ‐0.02 ± 0.35 mm, and 0.01 ± 0.40 mm in the AP, SI, and LR directions, and were 0.05 ± 0.23°, 0.02 ± 0.21°, and 0.00 ± 0.16° for rotations in yaw, roll, and pitch, respectively. There was a significant increase in intrafractional motion variance over time during treatments. Conclusion Patients with the vacuum fixation system had significantly smaller intrafractional motion variation compared to those with the open‐face mask system. Using intrafractional motion techniques such as surface imaging system is recommended to minimize dose deviation due to intrafractional motion. The increase in intrafractional motion over time indicates clinical benefits with shorter treatment time.
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Affiliation(s)
- Chunhui Han
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Jeffrey Y C Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Jieming Liang
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Kun Qing
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - W Tyler Watkins
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Sean Zhang
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Terence M Williams
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - An Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
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Jursinic P, Jordan K, Chen C. Positions of radiation isocenter and the couch rotation center established by Winston-Lutz and optical measurements. Tech Innov Patient Support Radiat Oncol 2022; 21:46-50. [PMID: 35243044 PMCID: PMC8861408 DOI: 10.1016/j.tipsro.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose To compare x-ray and optical imaging methods for measuring the relative position of radiation isocenter and couch rotation center. To show the impact of radiation isocenter size and target motion on the margins for target contours. Methods Winston-Lutz measurements are made using EPID images. Image analysis was done with public domain software, ImageJ, and spreadsheets written in Microsoft Excel. A comparison between the center of a high density test object and center of the MLC collimated beam is used to judge the relative position of the radiation isocenter in space for gantry and couch rotation. Additionally, motion of the target with couch rotation is determined with an optical imaging system. Five different accelerators, two TrueBeams, a Trilogy, and two VersaHDs, were assessed by Winston-Lutz and optical methods. Results The shift in the radiation isocenter with gantry rotation is found to be a tri-axial ellipsoid. Shifts in the target position with respect to radiation isocenter with couch rotation were between 0.4 and 0.6 mm. The Winston-Lutz and optical method determination of couch rotation center agreed within measurement uncertainty. Conclusions Image analysis yields precise data on linear accelerator radiation isocenter and rotation centers of the couch. The Winston-Lutz and optical methods agreed within measurement uncertainty.
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Affiliation(s)
- Paul Jursinic
- West Michigan Cancer Center, 200 North Park St., Kalamazoo, MI 49007, USA
- Corresponding author.
| | - Karl Jordan
- St. Vincent’s Private Hospital, Merrion Road, Dublin 4 D04 N2E0, Ireland
| | - Chen Chen
- West Michigan Cancer Center, 200 North Park St., Kalamazoo, MI 49007, USA
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Lawler G. A review of surface guidance in extracranial stereotactic body radiotherapy (SBRT/SABR) for set-up and intra-fraction motion management. Tech Innov Patient Support Radiat Oncol 2022; 21:23-26. [PMID: 35079644 PMCID: PMC8777133 DOI: 10.1016/j.tipsro.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/20/2021] [Accepted: 01/06/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction Surface guidance (SG) radiotherapy (RT) is now used by many radiotherapy departments globally and has expanded in popularity over the last number of years. A number of commercial systems are available. SG has routinely been used and is well established for cranial stereotactic radiosurgery (SRS) patient set ups and intra-fraction motion monitoring. However, data is limited in relation to its clinical use for extracranial stereotactic body radiotherapy (SBRT), particularly for targets which are impacted by respiratory motion such as the lung and liver. Objective & Information Source A review of available literature was carried out on 24th October 2021 to assess the clinical feasibility and use of SG in SBRT via PubMed. Methods Eligibility Criteria The search criteria involved identifying articles where SG is used in extracranial SBRT. Risk of Bias To eliminate the risk of bias, any particular commercial system was not the focus of the review and not included in the search criteria. Numerous clinical terms for similar things were used to reduce the risk of missing papers e.g. SBRT and SABR. Search Criteria The PRISMA checklist was used. Searching for “surface guidance and radiotherapy” yielded 3271 results, where as “SGRT” alone returned 72 results, when the search term was narrowed down using different iterations of SG and SBRT, only 6 results were available. Of these, 4 had reviewed clinical data in relation to SG and SBRT for patient set up and intra-fraction motion monitoring. Results The 4 studies indicate positive results for using SG with sufficient image guidance (IG) for both patient set up and intra-fraction monitoring during SBRT. This was observed both in free breathing and in patients with respiratory motion management being employed such as deep inspiration breath-hold (DIBH) techniques. All used multiple IGRT solutions to verify localisation pre-treatment in conjunction with SG. Limitations The number of studies available which report using SG in SBRT is extremely limited. All centres had also installed SG systems therefore this could result in an unconditional bias in using the system positively. Conclusion SG can be used for SBRT set-ups and intra-fraction motion monitoring once sufficient IG is used to verify target localisation for treatment.
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Al-Hallaq HA, Cerviño L, Gutierrez AN, Havnen-Smith A, Higgins SA, Kügele M, Padilla L, Pawlicki T, Remmes N, Smith K, Tang X, Tomé WA. AAPM task group report 302: Surface guided radiotherapy. Med Phys 2022; 49:e82-e112. [PMID: 35179229 PMCID: PMC9314008 DOI: 10.1002/mp.15532] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/26/2021] [Accepted: 02/05/2022] [Indexed: 11/06/2022] Open
Abstract
The clinical use of surface imaging has increased dramatically with demonstrated utility for initial patient positioning, real-time motion monitoring, and beam gating in a variety of anatomical sites. The Therapy Physics Subcommittee and the Imaging for Treatment Verification Working Group of the American Association of Physicists in Medicine commissioned Task Group 302 to review the current clinical uses of surface imaging and emerging clinical applications. The specific charge of this task group was to provide technical guidelines for clinical indications of use for general positioning, breast deep-inspiration breath-hold (DIBH) treatment, and frameless stereotactic radiosurgery (SRS). Additionally, the task group was charged with providing commissioning and on-going quality assurance (QA) requirements for surface guided radiation therapy (SGRT) as part of a comprehensive QA program including risk assessment. Workflow considerations for other anatomic sites and for computed tomography (CT) simulation, including motion management are also discussed. Finally, developing clinical applications such as stereotactic body radiotherapy (SBRT) or proton radiotherapy are presented. The recommendations made in this report, which are summarized at the end of the report, are applicable to all video-based SGRT systems available at the time of writing. Review current use of non-ionizing surface imaging functionality and commercially available systems. Summarize commissioning and on-going quality assurance (QA) requirements of surface image-guided systems, including implementation of risk or hazard assessment of surface guided radiotherapy as a part of a total quality management program (e.g., TG-100). Provide clinically relevant technical guidelines that include recommendations for the use of SGRT for general patient positioning, breast DIBH, and frameless brain SRS, including potential pitfalls to avoid when implementing this technology. Discuss emerging clinical applications of SGRT and associated QA implications based on evaluation of technology and risk assessment. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hania A Al-Hallaq
- Department of Radiation & Cellular Oncology, University of Chicago, Chicago, IL, 60637, USA
| | - Laura Cerviño
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Alonso N Gutierrez
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, 33173, USA
| | | | - Susan A Higgins
- Department of Therapeutic Radiology, Yale University, New Haven, CT, 06520, USA
| | - Malin Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University, Lund, 221 00, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, 221 00, Sweden
| | - Laura Padilla
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Todd Pawlicki
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Nicholas Remmes
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Koren Smith
- IROC Rhode Island, University of Massachusetts Chan Medical School, Lincoln, RI, 02865, USA
| | | | - Wolfgang A Tomé
- Department of Radiation Oncology and Department of Neurology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, 10461, USA
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Shanbhag NM, Antypas C, Msaddi AK, Murphy SC, Singh TT. Meningioma Treated With Hypofractionated Stereotactic Radiotherapy Using CyberKnife®: First in the United Arab Emirates. Cureus 2022; 14:e21821. [PMID: 35145829 PMCID: PMC8807952 DOI: 10.7759/cureus.21821] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 11/07/2022] Open
Abstract
A 26-year-old premenopausal lady was referred to the Department of Oncology with headaches and easy fatiguability. She had presented with the same complaints a few years ago. At that time, imaging revealed a right falcine space-occupying lesion (SOL), for which she underwent an unsuccessful attempt of excision. Imaging studies confirmed that the SOL was progressive and arose from the meninges. Previous excision failure was due to a network of blood vessels around the tumor and critical structures such as the thalamus and the brainstem, which made any approach challenging. The patient did not want further surgery and requested a non-surgical intervention. Considering the above, the case was discussed at the Multi-Disciplinary Tumor Board, and treatment with hypofractionated stereotactic radiotherapy using CyberKnife® was agreed upon. The patient received a total of 21 Gy in three fractions over six days and completed the treatment without any adverse reactions. This is the first case treated with hypofractionated stereotactic radiotherapy using the CyberKnife® in the United Arab Emirates, which is an effective and safe modality to treat similar challenging cases.
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Li G, Lu W, O'Grady K, Yan I, Yorke E, Arriba LIC, Powell S, Hong L. A uniform and versatile surface‐guided radiotherapy procedure and workflow for high‐quality breast deep‐inspiration breath‐hold treatment in a multi‐center institution. J Appl Clin Med Phys 2022; 23:e13511. [PMID: 35049108 PMCID: PMC8906224 DOI: 10.1002/acm2.13511] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/21/2021] [Accepted: 12/03/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose We share our experiences on uniformly implementing an effective and efficient SGRT procedure with a new clinical workflow for treating breast patients in deep‐inspiration breath‐hold (DIBH) among 9 clinical centers using 26 optical surface imaging (OSI) systems. Methods Our procedures have five major components: (1) acquiring both free‐breathing (FB) and DIBH computed tomography (CT) at simulation to quantify the rise of the anterior surface, (2) defining uniformly a large region of interest (ROI) to accommodate large variations in patient anatomy and treatment techniques, (3) performing two‐step setup in FB by first aligning the arm and chin to minimize breast deformation and reproduce local lymphnode positions and then aligning the ROI, (4) aligning the vertical shift precisely from FB to DIBH, and (5) capturing a new on‐site reference image at DIBH to separate residual setup errors from the DIBH motion monitoring uncertainties. Moreover, a new clinical workflow was developed for patient data preparation using 4 OSI offline workstations without interruption of SGRT treatment at 22 OSI online workstations. This procedure/workflow is suitable for all photon planning techniques, including 2‐field, 3‐field, 4‐field, partial breast irradiation (PBI), and volumetric‐modulated arc therapy (VMAT) with or without bolus. Results Since 2019, we have developed and applied the uniform breast SGRT DIBH procedure with optimized clinical workflow and ensured treatment accuracy among the nine clinics within our institution. About 150 breast DIBH patients are treated daily and two major upgrades are achieved smoothly throughout our institution, owing to the uniform and versatile procedure, adequate staff training, and efficient workflow with effective clinical supports and backup strategies. Conclusion The uniform and versatile breast SGRT DIBH procedure and workflow have been developed to ensure smooth and optimal clinical operations, simplify clinical staff training and clinical troubleshooting, and allow high‐quality SGRT delivery in a busy multi‐center institution.
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Affiliation(s)
- Guang Li
- Department of Medical Physics Memorial Sloan Kettering Cancer Center New York New York USA
| | - Wei Lu
- Department of Medical Physics Memorial Sloan Kettering Cancer Center New York New York USA
| | - Kyle O'Grady
- Department of Medical Physics Memorial Sloan Kettering Cancer Center New York New York USA
| | - Iris Yan
- Department of Medical Physics Memorial Sloan Kettering Cancer Center New York New York USA
| | - Ellen Yorke
- Department of Medical Physics Memorial Sloan Kettering Cancer Center New York New York USA
| | - Laura I Cervino Arriba
- Department of Medical Physics Memorial Sloan Kettering Cancer Center New York New York USA
| | - Simon Powell
- Department of Radiation Oncology Memorial Sloan Kettering Cancer Center New York New York USA
| | - Linda Hong
- Department of Medical Physics Memorial Sloan Kettering Cancer Center New York New York USA
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Cui T, Zhou Y, Yue NJ, Vergalasova I, Zhang Y, Zhu J, Nie K. Optimization of treatment isocenter location in single-isocenter LINAC-based stereotactic radiosurgery for management of multiple brain metastases. Med Phys 2021; 48:7632-7640. [PMID: 34655249 DOI: 10.1002/mp.15294] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 09/20/2021] [Accepted: 10/06/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Single-isocenter linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) has become a promising treatment technique for the management of multiple brain metastases. Because of the high prescription dose and steep dose gradient, SRS plans are sensitive to geometric errors, resulting in loss of target coverage and suboptimal local tumor control. Current planning techniques rely on adding a uniform and isotropic setup margin to all gross tumor volumes (GTVs) to account for rotational uncertainties. However, this setup margin may be insufficient, since the magnitude of rotational uncertainties varies and is dependent upon the distance between a GTV and the isocenter. In this study, we designed a framework to determine the optimal isocenter of a single-isocenter SRS plan for multiple brain metastases using stochastic optimization to mitigate potential errors resulting from rotational uncertainties. METHODS Planning target volumes (PTVs), defined as GTVs plus a 1-mm margin following common SRS planning convention, were assumed to be originally treated with a prescription dose and therefore covered by the prescription isodose cloud. The dose distribution, including the prescription isodose, was considered invariant assuming small rotations throughout the study. A stochastic optimization scheme was developed to determine the location of the optimal isocenter, so that the prescription dose coverage of rotated GTVs, equivalent to the intersecting volumes between the rotated GTVs and original PTVs, was maximized for any random small rotations about the isocenter. To evaluate the coverage of GTVs, the expected V 100 % undergoing random rotations was approximated as the sample average V 100 % undergoing a predetermined number of rotations. The expected V 100 % of each individual GTV and total GTVs was then compared between the plans using the optimal isocenter and the center-of-mass (CoM), respectively. RESULTS Twenty-two patients previously treated for multiple brain metastases in a single institute were included in this retrospective study. Each patient was initially treated for more than three brain metastases (mean: 7.6; range: 3-15) with the average GTV volume of 0.89 cc (range: 0.03-11.78 cc). The optimal isocenter found for each patient was significantly different from the CoM, with the average Euclidean distance between the optimal isocenter and the CoM being 4.36 ± 2.59 cm. The dose coverage to GTVs was also significantly improved (paired t-test; p < 0.001) when the optimal isocenter was used, with the average V 100 % of total GTVs increasing from 87.1% (standard deviation as std: 11.7%; range: 39.9-98.2%) to 94.2% (std: 5.4%; range: 77.7-99.4%). The volume of a GTV was positively correlated with the expected V 100 % regardless of the isocenter used (Spearman coefficient: ρ = 0.66 ; p < 0.001). The distance between a GTV and the isocenter was negatively correlated with the expected V 100 % when the CoM was used ( ρ = - 0.21 ; p = 0.004), however no significant correlation was found when the optimal isocenter was used ( ρ = - 0.11 ; p = 0.137). CONCLUSION The proposed framework provides an effective approach to determine the optimal isocenter of single-isocenter LINAC-based SRS plans for multiple brain metastases. The implementation of the optimal isocenter results in SRS plans with consistently higher target coverage despite potential rotational uncertainties, and therefore significantly improves SRS plan robustness against random rotational uncertainties.
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Affiliation(s)
- Taoran Cui
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Yongkang Zhou
- Department of Radiation Oncology, Zhongshan Hospital, Shanghai, China
| | - Ning J Yue
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Irina Vergalasova
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Yin Zhang
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Jiahua Zhu
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Ke Nie
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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Performance assessment of surface-guided radiation therapy and patient setup in head-and-neck and breast cancer patients based on statistical process control. Phys Med 2021; 89:243-249. [PMID: 34428608 DOI: 10.1016/j.ejmp.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/17/2021] [Accepted: 08/10/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To assess the effectiveness of SGRT in clinical applications through statistical process control (SPC). METHODS Taking the patients' positioning through optical surface imaging (OSI) as a process, the average level of process execution was defined as the process mean. Setup errors detected by cone-beam computed tomography (CBCT) and OSI were extracted for head-and-neck cancer (HNC) and breast cancer patients. These data were used to construct individual and exponentially weighted moving average (EWMA) control charts to analyze outlier fractions and small process shifts from the process mean. Using the control charts and process capability indices derived from this process, the patient positioning-related OSI performance and setup error were analyzed for each patient. RESULTS Outlier fractions and small shifts from the process mean that are indicative of setup errors were found to be widely prevalent, with the outliers randomly distributed between fractions. A systematic error of up to 1.6 mm between the OSI and CBCT results was observed in all directions, indicating a significantly degraded OSI performance. Adjusting this systematic error for each patient using setup errors of the first five fractions could effectively mitigate these effects. Process capability analysis following adjustment for systematic error indicated that OSI performance was acceptable (process capability index Cpk = 1.0) for HNC patients but unacceptable (Cpk < 0.75) for breast cancer patients. CONCLUSION SPC is a powerful tool for detecting the outlier fractions and process changes. Our application of SPC to patient-specific evaluations validated the suitability of OSI in clinical applications involving patient positioning.
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Rojas-López JA, Díaz Moreno RM, Venencia CD. Use of genetic algorithm for PTV optimization in single isocenter multiple metastases radiosurgery treatments with Brainlab Elements™. Phys Med 2021; 86:82-90. [PMID: 34062337 DOI: 10.1016/j.ejmp.2021.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/15/2021] [Accepted: 05/22/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To optimize PTV margins for single isocenter multiple metastases stereotactic radiosurgery through a genetic algorithm (GA) that determines the maximum effective displacement of each target (GTV) due to rotations. METHOD 10 plans were optimized. The plans were created with Elements Multiple Mets™ (Brainlab AG, Munchen, Germany) from a predefined template. The mean number of metastases per plan was 5 ± 2 [3,9] and the mean volume of GTV was 1.1 ± 1.3 cc [0.02, 5.1]. PTV margin criterion was based on GTV-isocenter distance and target dimensions. The effective displacement to perform specific rotational combination (roll, pitch, yaw) was optimized by GA. The original plans were re-calculated using the PTV optimized margin and new dosimetric variations were obtained. The Dmean, D99, Paddick conformity index (PCI), gradient index (GI) and dose variations in healthy brain were studied. RESULTS Regarding targets located shorter than 50 mm from the isocenter, the maximum calculated displacement was 2.5 mm. The differences between both PTV margin criteria were statistically significant for Dmean (p = 0.0163), D99 (p = 0.0439), PCI (p = 0.0242), GI (p = 0.0160) and for healthy brain V12 (p = 0.0218) and V10 (p = 0.0264). CONCLUSION The GA allows to determine an optimized PTV margin based on the maximum displacement. Optimized PTV margins reduce the detriment of dosimetric parameters. Greater PTV margins are associated with an increase in healthy brain volume.
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Covington EL, Popple RA. A Low-Cost Method to Assess the Performance of Surface Guidance Imaging Systems at Non-Zero Couch Angles. Cureus 2021; 13:e14278. [PMID: 33959456 PMCID: PMC8093097 DOI: 10.7759/cureus.14278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A procedure is presented to assess performance at non-zero couch angles and perform routine quality assurance (QA) on surface-guided radiotherapy (SGRT) imaging systems used for stereotactic radiosurgery (SRS). A low-cost anthropomorphic phantom was used to assess the system under patient-like conditions. The phantom is embedded with a tungsten ball bearing (BB) to facilitate the use of surface imaging (SI) with concurrent megavoltage (MV) imaging to cross-compare and validate SI-reported offsets. Data analysis is done via in-house software that utilized the SGRT system’s log files for automated analysis. This procedure enables users to assess and inter-compare MV-reported offsets with their SGRT system. The analysis provides SGRT system residual error so that users are aware of inherent offsets present in addition to increases in translational offsets due to couch walkout. The procedure was validated with two commercial SGRT systems. The procedure can be used with any surface imaging system and linear accelerator system.
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Affiliation(s)
| | - Richard A Popple
- Radiation Oncology, University of Alabama at Birmingham, Birmingham, USA
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Lee SK, Huang S, Zhang L, Ballangrud AM, Aristophanous M, Cervino Arriba LI, Li G. Accuracy of surface-guided patient setup for conventional radiotherapy of brain and nasopharynx cancer. J Appl Clin Med Phys 2021; 22:48-57. [PMID: 33792186 PMCID: PMC8130230 DOI: 10.1002/acm2.13241] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the accuracy of surface‐guided radiotherapy (SGRT) in cranial patient setup by direct comparison between optical surface imaging (OSI) and cone‐beam computed tomography (CBCT), before applying SGRT‐only setup for conventional radiotherapy of brain and nasopharynx cancer. Methods and Materials Using CBCT as reference, SGRT setup accuracy was examined based on 269 patients (415 treatments) treated with frameless cranial stereotactic radiosurgery (SRS) during 2018‐2019. Patients were immobilized in customized head molds and open‐face masks and monitored using OSI during treatment. The facial skin area in planning CT was used as OSI region of interest (ROI) for automatic surface alignment and the skull was used as the landmark for automatic CBCT/CT registration. A 6 degrees of freedom (6DOF) couch was used. Immediately after CBCT setup, an OSI verification image was captured, recording the SGRT setup differences. These differences were analyzed in 6DOFs and as a function of isocenter positions away from the anterior surface to assess OSI‐ROI bias. The SGRT in‐room setup time was estimated and compared with CBCT and orthogonal 2D kilovoltage (2DkV) setups. Results The SGRT setup difference (magnitude) is found to be 1.0 ± 2.5 mm and 0.1˚±1.4˚ on average among 415 treatments and within 5 mm/3˚ with greater than 95% confidence level (P < 0.001). Outliers were observed for very‐posterior isocenters: 15 differences (3.6%) are >5.0mm and 9 (2.2%) are >3.0˚. The setup differences show minor correlations (|r| < 0.45) between translational and rotational DOFs and a minor increasing trend (<1.0 mm) in the anterior‐to‐posterior direction. The SGRT setup time is 0.8 ± 0.3 min, much shorter than CBCT (5 ± 2 min) and 2DkV (2 ± 1 min) setups. Conclusion This study demonstrates that SGRT has sufficient accuracy for fast in‐room patient setup and allows real‐time motion monitoring for beam holding during treatment, potentially useful to guide radiotherapy of brain and nasopharynx cancer with standard fractionation.
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Affiliation(s)
- Sang Kyu Lee
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sheng Huang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lei Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ase M Ballangrud
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michalis Aristophanous
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura I Cervino Arriba
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guang Li
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Zhang L, Vijayan S, Huang S, Song Y, Li T, Li X, Hipp E, Chan MF, Kuo HC, Tang X, Tang G, Lim SB, Lovelock DM, Ballangrud A, Li G. Commissioning of optical surface imaging systems for cranial frameless stereotactic radiosurgery. J Appl Clin Med Phys 2021; 22:182-190. [PMID: 33779052 PMCID: PMC8130243 DOI: 10.1002/acm2.13240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/15/2020] [Accepted: 03/08/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose This study aimed to evaluate and compare different system calibration methods from a large cohort of systems to establish a commissioning procedure for surface‐guided frameless cranial stereotactic radiosurgery (SRS) with intrafractional motion monitoring and gating. Using optical surface imaging (OSI) to guide non‐coplanar SRS treatments, the determination of OSI couch‐angle dependency, baseline drift, and gated‐delivered‐dose equivalency are essential. Methods Eleven trained physicists evaluated 17 OSI systems at nine clinical centers within our institution. Three calibration methods were examined, including 1‐level (2D), 2‐level plate (3D) calibration for both surface image reconstruction and isocenter determination, and cube phantom calibration to assess OSI‐megavoltage (MV) isocenter concordance. After each calibration, a couch‐angle dependency error was measured as the maximum registration error within the couch rotation range. A head phantom was immobilized on the treatment couch and the isocenter was set in the middle of the brain, marked with the room lasers. An on‐site reference image was acquired at couch zero, the facial region of interest (ROI) was defined, and static verification images were captured every 10° for 0°–90° and 360°–270°. The baseline drift was assessed with real‐time monitoring of the motionless phantom over 20 min. The gated‐delivered‐dose equivalency was assessed using the electron portal imaging device and gamma test (1%/1mm) in reference to non‐gated delivery. Results The maximum couch‐angle dependency error occurs in longitudinal and lateral directions and is reduced significantly (P < 0.05) from 1‐level (1.3 ± 0.4 mm) to 2‐level (0.8 ± 0.3 mm) calibration. The MV cube calibration does not further reduce the couch‐angle dependency error (0.8 ± 0.2 mm) on average. The baseline drift error plateaus at 0.3 ± 0.1 mm after 10 min. The gated‐delivered‐dose equivalency has a >98% gamma‐test passing rate. Conclusion A commissioning method is recommended using the 3D plate calibration, which is verified by radiation isocenter and validated with couch‐angle dependency, baseline drift, and gated‐delivered‐dose equivalency tests. This method characterizes OSI uncertainties, ensuring motion‐monitoring accuracy for SRS treatments.
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Affiliation(s)
- Lei Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarath Vijayan
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sheng Huang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulin Song
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, Bergen, NJ, USA
| | - Tianfang Li
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, Commack, NY, USA
| | - Xiang Li
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, Nassau, NY, USA
| | - Elizabeth Hipp
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, Monmouth, NJ, USA
| | - Maria F Chan
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, Baskin Ridge, NJ, USA
| | - Hsiang-Chi Kuo
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, Norwalk, CT, USA
| | - Xiaoli Tang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, Westchester, NY, USA
| | - Grace Tang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Seng Boh Lim
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dale Michael Lovelock
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ase Ballangrud
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guang Li
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Bossart E, Mellon EA, Monterroso I, Elsayyad N, Diwanji T, Samuels S, Dogan N. Assessment of single isocenter linear accelerator radiosurgery for metastases and base of skull lesions. Phys Med 2020; 81:1-8. [PMID: 33278764 DOI: 10.1016/j.ejmp.2020.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/22/2020] [Accepted: 11/07/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Newer technology for stereotactic radiosurgery (SRS) should be assessed for different multi-leaf collimators (MLC). OBJECTIVE Assess plan quality of an automated, frameless, linear accelerator based (linac) planning and delivery system (HyperArc) for SRS using both standard MLC (SMLC) and high definition MLC (HDMLC) compared to a cobalt-60 based SRS system (Gamma Knife, GK). METHODS We re-planned twenty GK Perfexion-treated SRS patients (27 lesions) for HyperArc using SMLC and HDMLC. We assessed plan quality using the following metrics: gradient index (GI), Paddick and RTOG conformity indices (CIPaddick, CIRTOG), volume receiving half of prescription isodose (PIVhalf) and maximum dose to 0.03 cc for brainstem, optic chiasm and optic nerves, and V12Gy for brain-GTV. RESULTS Linac plans had better conformity with HDMLC being most conformal. GK exhibited better GI. PIVhalf demonstrated no statistically significant difference between HDMLC and GK, and SMLC was nominally worse than GK. Mean PIVhalf was generally 0.85 cc larger for SMLC than HDMLC. For TV > 1.0 cc, the relative differences in CIRTOG, GI, and PIVhalf for SMLC vs. HDMLC were less than 21%. For TV less than < 1.0 cc, there were more obvious relative differences for SMLC vs. HDMLC in CIRTOG (mean 146%, max 700%), GI (mean 49%, max 162%), and PIVhalf (mean 77%, max 522%). Organ at risk doses were met in all plans. CONCLUSIONS New linac-based plans positively compare to GK plans overall. HDMLC should be strongly considered for treatment of lesions < 1.0 cc given the significant improvements in conformity and PIVhalf over SMLC.
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Affiliation(s)
- Elizabeth Bossart
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Eric A Mellon
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Irene Monterroso
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nagy Elsayyad
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tejan Diwanji
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stuart Samuels
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nesrin Dogan
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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22
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Pallotta S, Kugele M, Redapi L, Ceberg S. Validation of a commercial deformable image registration for surface-guided radiotherapy using an ad hoc-developed deformable phantom. Med Phys 2020; 47:6310-6318. [PMID: 33034065 DOI: 10.1002/mp.14527] [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: 06/15/2020] [Revised: 08/31/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The use of optical surface systems (OSSs) for patient setup verification in external radiation therapy is increasing. To manage potential deformations in a patient's anatomy, a novel deformable image registration (DIR) tool has been applied in a commercial OSS. In this study we investigate the accuracy of the DIR as compared to rigid image registration (RR). METHODS AND MATERIALS The positioning accuracy of the DIR and RR implemented in the OSS was investigated using an ad hoc-developed anthropomorphic deformable phantom, named Mary. The phantom consists of 33 slices of expanded polystyrene slabs shaped thus to simulate part of a female body. Anatomical details, simulating the ribs and spinal cord, together with 10 inner targets at different depths are included in thorax and abdominal parts. Mary is capable of realistic body movements and deformations, such as head and arm rotations, body torsion and moderate breast/abdomen swelling. The accuracy of DIR and RR was investigated for four internal targets after deliberately deforming the phantom nine times. Breast and abdomen enlargements and torsions around x, y, and z axes were applied. For reference purposes, rigid displacements (where Mary's anatomy was kept intact) were included. The phantom was positioned on the linac couch under the OSS guidance and for each target and displacement a CBCT was acquired. The accuracy of DIR and RR was assessed evaluating the difference in means of absolute values between CBCT and the OSS registration parameters (lateral, longitudinal, vertical, rot, pitch, and roll), using both a reference surface extracted from CT (CTr) or acquired with the OSS (OSSr). A comparison of the four different combinations, DIR + OSSr, DIR + CTr, RR + OSSr, and RR + CTr, was carried out to evaluate the position accuracy for the various combinations. Finally, the positioning accuracy of the different target positions using only OSSr was investigated for the DIR. A paired sample Wilcoxon signed-rank test (P < 0.05) and a two-tailed Mann-Whitney test (P < 0.05) were carried out. RESULTS The DIR in combination with OSSr showed significantly (P < 0.05) improved positioning accuracy in the lateral and longitudinal directions and in pitch, compared to RR, when deformations were applied to Mary. The positioning accuracy improved from 1.9 ± 1.5 mm, 1.1 ± 0.8 mm to 1.1 ± 1.2 mm, 0.6 ± 0.5 mm in lateral and longitudinal directions, respectively, and from 0.8 ± 0.6° to 0.4 ± 0.4° in pitch, using DIR compared to RR. Both the DIR and RR showed a similar positioning accuracy when rigid displacements of Mary were applied. For DIR, the OSSr generally showed improved calculation accuracy compared to CTr. Independent of the reference image used, the target position influenced the registration accuracy, and hence, one target could not be evaluated using RR due to its inability to calculate the correct position. CONCLUSIONS Improved positioning accuracy was observed for DIR with respect to RR when deformations of Mary's anatomy were applied. For both DIR and RR, improved positioning accuracy was observed using OSSr as compared to CTr. The position of the target inside the phantom influenced the positioning accuracy for DIR.
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Affiliation(s)
- Stefania Pallotta
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy.,Medical Physics Unit AOU Careggi, Florence, Italy
| | - Malin Kugele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Laura Redapi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sofie Ceberg
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
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23
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Chen L, Bai S, Li G, Li Z, Xiao Q, Bai L, Li C, Xian L, Hu Z, Dai G, Wang G. Accuracy of real-time respiratory motion tracking and time delay of gating radiotherapy based on optical surface imaging technique. Radiat Oncol 2020; 15:170. [PMID: 32650819 PMCID: PMC7350729 DOI: 10.1186/s13014-020-01611-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/02/2020] [Indexed: 02/08/2023] Open
Abstract
Background Surface-guided radiation therapy (SGRT) employs a non-invasive real-time optical surface imaging (OSI) technique for patient surface motion monitoring during radiotherapy. The main purpose of this study is to verify the real-time tracking accuracy of SGRT for respiratory motion and provide a fitting method to detect the time delay of gating. Methods A respiratory motion phantom was utilized to simulate respiratory motion using 17 cosine breathing pattern curves with various periods and amplitudes. The motion tracking of the phantom was performed by the Catalyst™ system. The tracking accuracy of the system (with period and amplitude variations) was evaluated by analyzing the adjusted coefficient of determination (A_R2) and root mean square error (RMSE). Furthermore, 13 actual respiratory curves, which were categorized into regular and irregular patterns, were selected and then simulated by the phantom. The Fourier transform was applied to the respiratory curves, and tracking accuracy was compared through the quantitative analyses of curve similarity using the Pearson correlation coefficient (PCC). In addition, the time delay of amplitude-based respiratory-gating radiotherapy based on the OSI system with various beam hold times was tested using film dosimetry for the Elekta Versa-HD and Varian Edge linacs. A dose convolution-fitting method was provided to accurately measure the beam-on and beam-off time delays. Results A_R2 and RMSE for the cosine curves were 0.9990–0.9996 and 0.110–0.241 mm for periods ranging from 1 s to 10 s and 0.9990–0.9994 and 0.059–0.175 mm for amplitudes ranging from 3 mm to 15 mm. The PCC for the actual respiratory curves ranged from 0.9955 to 0.9994, which was not significantly affected by breathing patterns. For gating radiotherapy, the average beam-on and beam-off time delays were 1664 ± 72 and 25 ± 30 ms for Versa-HD and 303 ± 45 and 34 ± 25 ms for Edge, respectively. The time delay was relatively stable as the beam hold time increased. Conclusions The OSI technique provides high accuracy for respiratory motion tracking. The proposed dose convolution-fitting method can accurately measure the time delay of respiratory-gating radiotherapy. When the OSI technique is used for respiratory-gating radiotherapy, the time delay for the beam-on is considerably longer than the beam-off.
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Affiliation(s)
- Li Chen
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,School of Physics and Technology, Wuhan University, Wuhan, China
| | - Sen Bai
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Guangjun Li
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
| | - Zhibin Li
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Xiao
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Long Bai
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Changhu Li
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Lixun Xian
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenyao Hu
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Guyu Dai
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Guangyu Wang
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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24
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Semeniuk O, Sadeghi P, Farah JD, Moran K, Robar J. Performance optimization of capacitive motion sensing (CMS) system for intra-fraction motion detection during stereotactic radiosurgery. Biomed Phys Eng Express 2019; 6:015013. [DOI: 10.1088/2057-1976/ab5bff] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Flores-Martinez E, Cerviño LI, Pawlicki T, Kim GY. Assessment of the use of different imaging and delivery techniques for cranial treatments on the Halcyon linac. J Appl Clin Med Phys 2019; 21:53-61. [PMID: 31738473 PMCID: PMC6964767 DOI: 10.1002/acm2.12772] [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] [Received: 05/27/2019] [Revised: 08/01/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose In this work, we investigated the effect on the workflow and setup accuracy of using surface guided radiation therapy (SGRT) for patient setup, megavoltage cone beam CT (MVCBCT) or kilovoltage cone beam CT (kVCBCT) for imaging and fixed IMRT or volumetric‐modulated arc therapy (VMAT) for treatment delivery with the Halcyon linac. Methods We performed a retrospective investigation of 272 treatment fractions, using three different workflows. The first and second workflows used MVCBCT and fixed IMRT for imaging and treatment delivery, and the second one also used SGRT for patient setup. The third workflow used SGRT for setup, kVCBCT for imaging and VMAT for delivery. Workflows were evaluated by comparing the number of fractions requiring repeated imaging acquisitions and the time required for setup, imaging and treatment delivery. Setup position accuracy was assessed by comparing the daily kV‐ or MV‐ CBCT with the planning CT and measuring the residual rotational errors for pitch, yaw and roll angles. Results Without the use of SGRT, the imaging fields were delivered more than once on 11.1% of the fractions, while re‐imaging was necessary in 5.5% of the fractions using SGRT. The total treatment time, including setup, imaging, and delivery, for the three workflows was 531 ± 157 s, 503 ± 130 s and 457 ± 91 s, respectively. A statistically significant difference was observed when comparing the third workflow with the first two. The total residual rotational errors were 1.96 ± 1.29°, 1.28 ± 0.67° and 1.22 ± 0.76° and statistically significant differences were observed when comparing workflows with and without SGRT. Conclusions The use of SGRT allowed for a reduction of re‐imaging during patient setup and improved patient position accuracy by reducing residual rotational errors. A reduction in treatment time using kVCBCT with SGRT was observed. The most efficient workflow was the one including kVCBCT and SGRT for setup and VMAT for delivery.
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Affiliation(s)
- Everardo Flores-Martinez
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Laura I Cerviño
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Todd Pawlicki
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Gwe-Ya Kim
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
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26
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Covington EL, Fiveash JB, Wu X, Brezovich I, Willey CD, Riley K, Popple RA. Optical surface guidance for submillimeter monitoring of patient position during frameless stereotactic radiotherapy. J Appl Clin Med Phys 2019; 20:91-98. [PMID: 31095866 PMCID: PMC6560239 DOI: 10.1002/acm2.12611] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/10/2019] [Accepted: 04/18/2019] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the accuracy of monitoring intrafraction motion during stereotactic radiotherapy with the optical surface monitoring system. Prior studies showing a false increase in the magnitude of translational offsets at non-coplanar couch positions prompted the vendor to implement software changes. This study evaluated two software improvements intended to address false offsets. METHODS The vendor implemented two software improvements: a volumetric (ACO) rather than planar calibration and, approximately 6 months later, an improved calibration workflow (CIB) designed to better compensate for thermal drift. Offsets relative to the reference position, obtained at table angle 0 following image-guided setup, were recorded before beam-on at each table position and at the end of treatment the table returned to 0° for patients receiving SRT. RESULTS Prior to ACO, between ACO and CIB, and after CIB, 223, 155, and 436 fractions were observed respectively. The median magnitude of translational offsets at the end of treatment was similar for all three intervals: 0.29, 0.33, and 0.27 mm. Prior to ACO, the offset magnitude for non-zero table positions had a median of 0.79 mm and was found to increase with increasing distance from isocenter to the anterior patient surface. After ACO, the median magnitude was 0.74 mm, but the dependence on surface-to-isocenter distance was eliminated. After CIB, the median magnitude for non-zero table positions was reduced to 0.57 mm. CONCLUSION Ongoing improvements in software and calibration procedures have decreased reporting of false offsets at non-zero table angles. However, the median magnitude for non-zero table angles is larger than that observed at the end of treatment, indicating that accuracy remains better when the table is not rotated.
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Affiliation(s)
- Elizabeth L Covington
- Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL, USA
| | - John B Fiveash
- Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Xingen Wu
- Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Ivan Brezovich
- Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Christopher D Willey
- Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Kristen Riley
- Department of Neurosurgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Richard A Popple
- Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL, USA
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27
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Kang CL, Liu SC, Wang JC, Liao KC, Huang YJ, Fang FM, Liao TI, Juan KJ, Huang CC. Comparison of Skull Motions in Six Degrees of Freedom Between Two Head Supports During Frameless Radiosurgery by CyberKnife. Front Oncol 2018; 8:359. [PMID: 30234018 PMCID: PMC6131575 DOI: 10.3389/fonc.2018.00359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/14/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction: Maintaining immobilization to minimize skull motion is important during frameless radiosurgery. This study aimed to compare the intrafractional skull motions between two head supports. Methods: With 6D skull tracking system, 4,075 image records from 45 patients receiving radiosurgery by CyberKnife were obtained. Twenty-three patients used TIMO head supports (CIVCO) (Group A) and twenty-two patients used Silverman head supports (CIVCO) with MoldCare cushions (ALCARE) (Group B). The skull motions in X (superior-inferior), Y (right-left), Z (anterior-posterior) axes, 3D (three-dimensional) vector, Roll, Pitch and Yaw between the two groups were compared and the margins of planning target volume were estimated. Results: The translational motions in Group A were similar in three axes at initial but became different after 10 min, and those in Group B were less prominent in the Y axis. The rotational errors in Group A were most obvious in Yaw, but those in Group B were stationary in three axes. The motions in the X axis, 3D vector, Pitch and Yaw in Group B were significantly smaller than those in Group A; conversely, the motions in the Z axis in Group B were larger. To cover the 95% confidence intervals, margins of 0.77, 0.79, and 0.40 mm in the X, Y, and Z axes, respectively, were needed in Group A, and 0.69, 0.50, and 0.51 mm were needed in Group B. Conclusions: Both head supports could provide good immobilization during the frameless radiosurgery. Silverman head support with MoldCare cushion was better than TIMO head support in the superior-inferior direction, 3D vector, Pitch and Yaw axes, but worse in the anterior-posterior direction.
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Affiliation(s)
- Chen-Lin Kang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Shyh-Chang Liu
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Jui-Chu Wang
- Department of Anatomical Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuan-Cho Liao
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Min Fang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-I Liao
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Jung Juan
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Chieh Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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28
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Ballangrud Å, Kuo LC, Happersett L, Lim SB, Beal K, Yamada Y, Hunt M, Mechalakos J. Institutional experience with SRS VMAT planning for multiple cranial metastases. J Appl Clin Med Phys 2018; 19:176-183. [PMID: 29476588 PMCID: PMC5849827 DOI: 10.1002/acm2.12284] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/15/2017] [Accepted: 12/27/2017] [Indexed: 12/14/2022] Open
Abstract
Background and Purpose This study summarizes the cranial stereotactic radiosurgery (SRS) volumetric modulated arc therapy (VMAT) procedure at our institution. Materials and Methods Volumetric modulated arc therapy plans were generated for 40 patients with 188 lesions (range 2–8, median 5) in Eclipse and treated on a TrueBeam STx. Limitations of the custom beam model outside the central 2.5 mm leaves necessitated more than one isocenter pending the spatial distribution of lesions. Two to nine arcs were used per isocenter. Conformity index (CI), gradient index (GI) and target dose heterogeneity index (HI) were determined for each lesion. Dose to critical structures and treatment times are reported. Results Lesion size ranged 0.05–17.74 cm3 (median 0.77 cm3), and total tumor volume per case ranged 1.09–26.95 cm3 (median 7.11 cm3). For each lesion, HI ranged 1.2–1.5 (median 1.3), CI ranged 1.0–2.9 (median 1.2), and GI ranged 2.5–8.4 (median 4.4). By correlating GI to PTV volume a predicted GI = 4/PTV0.2 was determined and implemented in a script in Eclipse and used for plan evaluation. Brain volume receiving 7 Gy (V7 Gy) ranged 10–136 cm3 (median 42 cm3). Total treatment time ranged 24–138 min (median 61 min). Conclusions Volumetric modulated arc therapy provide plans with steep dose gradients around the targets and low dose to critical structures, and VMAT treatment is delivered in a shorter time than conventional methods using one isocenter per lesion. To further improve VMAT planning for multiple cranial metastases, better tools to shorten planning time are needed. The most significant improvement would come from better dose modeling in Eclipse, possibly by allowing for customizing the dynamic leaf gap (DLG) for a special SRS model and not limit to one DLG per energy per treatment machine and thereby remove the limitation on the Y‐jaw and allow planning with a single isocenter.
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Affiliation(s)
- Åse Ballangrud
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Li Cheng Kuo
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura Happersett
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Seng Boh Lim
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathryn Beal
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Margie Hunt
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Mechalakos
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Soufi M, Arimura H, Nakamura K, Lestari FP, Haryanto F, Hirose TA, Umedu Y, Shioyama Y, Toyofuku F. Feasibility of differential geometry-based features in detection of anatomical feature points on patient surfaces in range image-guided radiation therapy. Int J Comput Assist Radiol Surg 2016; 11:1993-2006. [PMID: 27295052 DOI: 10.1007/s11548-016-1436-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/27/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the feasibility of differential geometry features in the detection of anatomical feature points on a patient surface in infrared-ray-based range images in image-guided radiation therapy. METHODS The key technology was to reconstruct the patient surface in the range image, i.e., point distribution with three-dimensional coordinates, and characterize the geometrical shape at every point based on curvature features. The region of interest on the range image was extracted by using a template matching technique, and the range image was processed for reducing temporal and spatial noise. Next, a mathematical smooth surface of the patient was reconstructed from the range image by using a non-uniform rational B-splines model. The feature points were detected based on curvature features computed on the reconstructed surface. The framework was tested on range images acquired by a time-of-flight (TOF) camera and a Kinect sensor for two surface (texture) types of head phantoms A and B that had different anatomical geometries. The detection accuracy was evaluated by measuring the residual error, i.e., the mean of minimum Euclidean distances (MMED) between reference (ground truth) and detected feature points on convex and concave regions. RESULTS The MMEDs obtained using convex feature points for range images of the translated and rotated phantom A were [Formula: see text] and [Formula: see text], respectively, using the TOF camera. For the phantom B, the MMEDs of the convex and concave feature points were [Formula: see text] and [Formula: see text] mm, respectively, using the Kinect sensor. There was a statistically significant difference in the decreased MMED for convex feature points compared with concave feature points [Formula: see text]. CONCLUSIONS The proposed framework has demonstrated the feasibility of differential geometry features for the detection of anatomical feature points on a patient surface in range image-guided radiation therapy.
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Affiliation(s)
- Mazen Soufi
- Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hidetaka Arimura
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Katsumasa Nakamura
- Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Shizuoka, 431-3192, Japan
| | | | | | - Taka-Aki Hirose
- Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshiyuki Umedu
- Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshiyuki Shioyama
- Saga Heavy Ion Medical Accelerator, 415, Harakoga-machi, Tosu, 841-0071, Japan
| | - Fukai Toyofuku
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Wong K, Opimo AB, Olch AJ, All S, Waxer JF, Clark D, Cheng J, Chlebik A, Erdreich-Epstein A, Krieger MD, Tamrazi B, Dhall G, Finlay JL, Chang EL. Re-irradiation of Recurrent Pineal Germ Cell Tumors with Radiosurgery: Report of Two Cases and Review of Literature. Cureus 2016; 8:e585. [PMID: 27239400 PMCID: PMC4882159 DOI: 10.7759/cureus.585] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Primary intracranial germ cell tumors are rare, representing less than 5% of all central nervous system tumors. Overall, the majority of germ cell tumors are germinomas and approximately one-third are non-germinomatous germ cell tumors (NGGCT), which include teratoma, embryonal carcinoma, yolk sac tumor (endodermal sinus tumor), choriocarcinoma, or mixed malignant germ cell tumor. Germ cell tumors may secrete detectable levels of proteins into the blood and/or cerebrospinal fluid, and these proteins can be used for diagnostic purposes or to monitor tumor recurrence. Germinomas have long been known to be highly curable with radiation therapy alone. However, many late effects of whole brain or craniospinal irradiation have been well documented. Strategies have been developed to reduce the dose and volume of radiation therapy, often in combination with chemotherapy. In contrast, patients with NGGCT have a poorer prognosis, with about 60% cured with multimodality chemoradiation. There are no standard approaches for relapsed germ cell tumors. Options may be limited by prior treatment. Radiation therapy has been utilized alone or in combination with chemotherapy or high-dose chemotherapy and transplant. We discuss two cases and review options for frameless radiosurgery or fractionated radiotherapy.
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Affiliation(s)
- Kenneth Wong
- Department of Radiation Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | | - Arthur J Olch
- Department of Radiation Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Sean All
- College of Medicine, University of Central Florida College of Medicine, Orlando, FL
| | - Jonathan F Waxer
- School of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Desirae Clark
- Radiation Oncology Program, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA
| | - Justine Cheng
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA
| | - Alisha Chlebik
- Radiation Oncology Program, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA
| | - Anat Erdreich-Epstein
- Neuro-Oncology Program, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA ; Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Mark D Krieger
- Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Benita Tamrazi
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Girish Dhall
- Pediatric Neuro-Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Jonathan L Finlay
- Pediatric Neuro-Oncology, The Ohio State University, Nationwide Children's Hospital
| | - Eric L Chang
- Department of Radiation Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
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Wiant D, Squire S, Liu H, Maurer J, Lane Hayes T, Sintay B. A prospective evaluation of open face masks for head and neck radiation therapy. Pract Radiat Oncol 2016; 6:e259-e267. [PMID: 27025164 DOI: 10.1016/j.prro.2016.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/03/2016] [Accepted: 02/10/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Head and neck (HN) radiation therapy patients are typically immobilized with closed thermoplastic masks that cover the face and may cause discomfort. In this work, we examine the use of open masks for HN radiation therapy. METHODS AND MATERIALS Fifty HN patients were prospectively randomized into 2 groups (25 closed masks, 25 open masks). The open-mask group was monitored with surface imaging to evaluate intrafraction motion. Both groups underwent daily volumetric imaging. All daily images were rigidly registered to their respective planning images to evaluate spinal canal and mandible position as a check for interfraction posture change. Posture changes were determined by the amount the spinal canal and mandible contours from the planning images had to be expanded to cover the structures on each daily image set. The vector length (VL) of the intrafraction linear translations, spine, and mandible positions for each open-mask patient were checked for correlation with fraction number using the Pearson r value. All patients were given a weekly survey ranking anxiety and claustrophobia from 0 to 10 (0 = no issue, 10 = extreme issue). RESULTS The mean VL for all open-mask patients was 0.9 ± 0.5 mm (1 standard deviation). Only 1 patient showed significant correlation between VL and fraction number. The mean contour expansions to cover the spine and mandible were 1.5 ± 0.9 mm and 1.8 ± 1.3 mm for the closed-mask group, and 1.6 ± 0.8 mm and 1.8 ± 1.1 mm for the open-mask group. Both groups showed similar behavior relative to fraction number. The mean anxiety and claustrophobia scores were 1.63 and 1.44 for the closed-mask group, and 0.81 and 0.63 for the open-mask group. The groups were not significantly different. CONCLUSIONS Open masks provide comparable immobilization and posture preservation to closed masks for HN radiation therapy.
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Affiliation(s)
- David Wiant
- Cone Health Cancer Center, Greensboro, North Carolina.
| | - Sarah Squire
- Cone Health Cancer Center, Greensboro, North Carolina
| | - Han Liu
- Cone Health Cancer Center, Greensboro, North Carolina
| | | | - T Lane Hayes
- Cone Health Cancer Center, Greensboro, North Carolina
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