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Kirby J, Chester K. Automation to facilitate optimisation of breast radiotherapy treatments using EPID-based in vivodosimetry. Phys Med Biol 2024; 69:095018. [PMID: 38537296 DOI: 10.1088/1361-6560/ad387e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/26/2024] [Indexed: 04/25/2024]
Abstract
Objective. To use automation to facilitate the monitoring of each treatment fraction using an electronic portal imaging device (EPID) basedin vivodosimetry (IVD) system, allowing optimisation of breast radiotherapy delivery for individual patients and cohorts.Approach. A suite of in-house software was developed to reduce the number of manual interactions with the commercial IVD system, dosimetry check. An EPID specific pixel sensitivity map facilitated use of the EPID panel away from the central axis. Point dose difference and the change in standard deviation in dose were identified as useful dose metrics, with standard deviation used in preference to gamma in the presence of a systematic dose offset. Automated IVD was completed for 3261 fractions across 704 patients receiving breast radiotherapy.Main results. Multiple opportunities for treatment optimisation were identified for individual patients and across patient cohorts as a result of successful implementation of automated IVD. 5.1% of analysed fractions were out of tolerance with 27.1% of these considered true positives. True positive results were obtained on any fraction of treatment and if IVD had only been completed on the first fraction, 84.4% of true positive results would have been missed. This was made possible due to the automation that saved over 800 h of manual intervention and stored data in an accessible database.Significance. An improved EPID calibration to allow off-axis measurement maximises the number of patients eligible for IVD (36.8% of patients in this study). We also demonstrate the importance in selecting context-specific assessment metrics and how these can lead to a managable false positive rate. We have shown that the use of fully automated IVD facilitates use on every fraction of treatment. This leads to identification of areas for treatment improvement for both individuals and across a patient cohort, expanding the uses of IVD from simply gross error detection towards treatment optimisation.
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Affiliation(s)
- Joshua Kirby
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, United Kingdom
| | - Katherine Chester
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumberland Infirmary, United Kingdom
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Tardi D, Fitriandini A, Fauziah AR, Wibowo WE, Siswantining T, Pawiro SA. Analysis of dose distribution reproducibility based on a fluence map of in vivo transit dose using an electronic portal imaging device. Biomed Phys Eng Express 2023; 10:015013. [PMID: 38052064 DOI: 10.1088/2057-1976/ad124a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/05/2023] [Indexed: 12/07/2023]
Abstract
Morphological changes can affect distribution of dose in patients. Determination of the dose distribution changes for each fraction radiotherapy can be done by relativein vivodosimetry (IVD). This study analysed the distribution of doses per fraction based on the fluence map recorded by the electronic portal imaging device (EPID) of the patient's transit dose. This research examined cases involving the cervix, breast, and nasopharynx. Transit dose analysis was performed by calculating the gamma index (GI) with composite and field-by-field methods. The gamma passing rate (GPR) value was assessed for its correlation with the subject's body weight. In the case of the nasopharynx, breast, and cervix, the GPR value decreased as the fraction increased. In the case of the nasopharynx, the correlation between the GPR and fraction radiotherapy showed no difference when using either composite or field-by-field methods. However, in cases involving the cervix and breast, there was a difference in the correlation values between the composite and field-by-field methods, where the subject had a significant correlation (p< 0.05) when it was done using a field-by-field method. In addition, the nasopharynx had the highest number of subjects with significant correlation (p< 0.05) between GPR and body weight, followed by the cervix and breast. In the nasopharynx, breast, and cervix, the reproducibility of the dose distribution decreased. This decreased reproducibility was associated with changes in body weight.
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Affiliation(s)
- Didin Tardi
- Department of Physics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Depok, West Java, 16424, Indonesia
| | - Aninda Fitriandini
- Department of Radiation Oncology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo General Hospital, Jakarta, 10430, Indonesia
| | - Annisa Rahma Fauziah
- Department of Radiation Oncology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo General Hospital, Jakarta, 10430, Indonesia
| | - Wahyu Edy Wibowo
- Department of Radiation Oncology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo General Hospital, Jakarta, 10430, Indonesia
| | - Titin Siswantining
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Depok, West Java, 16424, Indonesia
| | - Supriyanto Ardjo Pawiro
- Department of Physics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Depok, West Java, 16424, Indonesia
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Sheen H, Park YI, Cho MS, Son J, Shin HB, Han MC, Kim H, Lee H, Kim DW, Kim JS, Hong CS. Novel framework for determining TPS-calculated doses corresponding to detector locations using 3D camera in in vivosurface dosimetry. Phys Med Biol 2023; 68. [PMID: 36753768 DOI: 10.1088/1361-6560/acba78] [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: 10/25/2022] [Accepted: 02/08/2023] [Indexed: 02/10/2023]
Abstract
Purpose. To address the shortcomings of current procedures for evaluating the measured-to-planned dose agreement inin vivodosimetry (IVD), this study aimed to develop an accurate and efficient novel framework to identify the detector location placed on a patient's skin surface using a 3D camera and determine the planned dose at the same anatomical position corresponding to the detector location.Methods. Breast cancer treatment was simulated using an anthropomorphic adult female phantom (ATOM 702D; CIRS, Norfolk, VA, USA). An optically stimulated luminescent dosimeter was used for surface dose measurements (MyOSLchip, RadPro International GmbH, Germany) at six IVD points. Three-dimensional surface imaging (3DSI) of the phantom with the detector was performed in the treatment position using a 3D camera. The developed framework, iSMART, was designed to import 3DSI and treatment planning data for determining the position of the IVD detectors in the 3D treatment planning DICOM image. The clinical usefulness of iSMART was evaluated in terms of accuracy and efficiency, for comparison with the results obtained using cone-beam computed tomography (CBCT) image guidance.Results. The relative dose difference between the planned doses determined using iSMART and CBCT images displayed similar accuracies (within approximately ±2.0%) at all detector locations. The relative dose differences between the planned and measured doses at the six detector locations ranged from -4.8% to 3.1% for the CBCT images and -3.5% to 2.1% for iSMART. The total time required to read the planned doses at six detector locations averaged at 8.1 and 0.8 min for the CBCT images and iSMART, respectively.Conclusions. The proposed framework can improve the robustness of IVD analyses and aid in accurate and efficient evaluations of the measured-to-planned dose agreement.
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Affiliation(s)
- Heesoon Sheen
- Department of Health Sciences and Technology, SamSung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Republic of Korea
| | - Ye-In Park
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min-Seok Cho
- Department of Radiation Oncology, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Junyoung Son
- Department of Radiation Oncology, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Han-Back Shin
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Cheol Han
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hojin Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ho Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Wook Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
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Esposito M, Piermattei A, Bresciani S, Orlandini LC, Falco MD, Giancaterino S, Cilla S, Ianiro A, Nigro R, Botez L, Riccardi S, Fidanzio A, Greco F, Villaggi E, Russo S, Stasi M. Improving dose delivery accuracy with EPID in vivo dosimetry: results from a multicenter study. Strahlenther Onkol 2021; 197:633-643. [PMID: 33594471 DOI: 10.1007/s00066-021-01749-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/22/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate critical aspects and effectiveness of in vivo dosimetry (IVD) tests obtained by an electronic portal imaging device (EPID) in a multicenter and multisystem context. MATERIALS AND METHODS Eight centers with three commercial systems-SoftDiso (SD, Best Medical Italy, Chianciano, Italy), Dosimetry Check (DC, Math Resolution, LCC), and PerFRACTION (PF, Sun Nuclear Corporation, SNC, Melbourne, FL)-collected IVD results for a total of 2002 patients and 32,276 tests. Data are summarized for IVD software, radiotherapy technique, and anatomical site. Every center reported the number of patients and tests analyzed, and the percentage of tests outside of the tolerance level (OTL%). OTL% was categorized as being due to incorrect patient setup, incorrect use of immobilization devices, incorrect dose computation, anatomical variations, and unknown causes. RESULTS The three systems use different approaches and customized alert indices, based on local protocols. For Volumetric Modulated Arc Therapy (VMAT) treatments OTL% mean values were up to 8.9% for SD, 18.0% for DC, and 16.0% for PF. Errors due to "anatomical variations" for head and neck were up to 9.0% for SD and DC and 8.0% for PF systems, while for abdomen and pelvis/prostate treatments were up to 9%, 17.0%, and 9.0% for SD, DC, and PF, respectively. The comparison among techniques gave 3% for Stereotactic Body Radiation Therapy, 7.0% (range 4.7-8.9%) for VMAT, 10.4% (range 7.0-12.2%) for Intensity Modulated Radiation Therapy, and 13.2% (range 8.8-21.0%) for 3D Conformal Radiation Therapy. CONCLUSION The results obtained with different IVD software and among centers were consistent and showed an acceptable homogeneity. EPID IVD was effective in intercepting important errors.
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Affiliation(s)
- M Esposito
- S. C. Fisica Sanitaria Firenze-Empoli, Medical Physics Unit of Radiation Oncology Dept., Azienda Sanitaria USL Toscana Centro Florence, Via dell'Antella 58, 50012, Bagno a Ripoli, Firenze, Italy.
| | - A Piermattei
- UOC di Fisica Sanitaria, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - S Bresciani
- Medical Physics, Candiolo Cancer Institute-FPO IRCCS, Turin, Italy
| | - L C Orlandini
- Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu, China
| | - M D Falco
- Dipartimento di Radioterapia, Università di Chieti, Chieti, Italy
| | - S Giancaterino
- Dipartimento di Radioterapia, Università di Chieti, Chieti, Italy
| | - S Cilla
- Medical Physics Unit, Fondazione di ricerca e cura "Giovanni Paolo II", Campobasso, Italy
| | - A Ianiro
- Medical Physics Unit, Fondazione di ricerca e cura "Giovanni Paolo II", Campobasso, Italy
| | - R Nigro
- OGP S. Camillo de Lellis, Rieti, Italy
| | - L Botez
- Medical Physics, Candiolo Cancer Institute-FPO IRCCS, Turin, Italy
| | | | - A Fidanzio
- UOC di Fisica Sanitaria, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - F Greco
- UOC di Fisica Sanitaria, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - S Russo
- S. C. Fisica Sanitaria Firenze-Empoli, Azienda Sanitaria USL Toscana Centro Florence, Florence, Italy
| | - M Stasi
- S.C. Fisica Sanitaria, A.O. Ordine Mauriziano di Torino, Torino, Italy
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Esposito M, Villaggi E, Bresciani S, Cilla S, Falco MD, Garibaldi C, Russo S, Talamonti C, Stasi M, Mancosu P. Estimating dose delivery accuracy in stereotactic body radiation therapy: A review of in-vivo measurement methods. Radiother Oncol 2020; 149:158-167. [PMID: 32416282 DOI: 10.1016/j.radonc.2020.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiation therapy (SBRT) has been recognized as a standard treatment option for many anatomical sites. Sophisticated radiation therapy techniques have been developed for carrying out these treatments and new quality assurance (QA) programs are therefore required to guarantee high geometrical and dosimetric accuracy. This paper focuses on recent advances on in-vivo measurements methods (IVM) for SBRT treatment. More specifically, all of the online QA methods for estimating the effective dose delivered to patients were compared. Determining the optimal IVM for performing SBRT treatments would reduce the risk of errors that could jeopardize treatment outcome. A total of 89 papers were included. The papers were subdivided into the following topics: point dosimeters (PD), transmission detectors (TD), log file analysis (LFA), electronic portal imaging device dosimetry (EPID), dose accumulation methods (DAM). The detectability capability of the main IVM detectors/devices were evaluated. All of the systems have some limitations: PD has no spatial data, EPID has limited sensitivity towards set-up errors and intra-fraction motion in some anatomical sites, TD is insensitive towards patient related errors, LFA is not an independent measure, DAMs are not always based on measures. In order to minimize errors in SBRT dose delivery, we recommend using synergic combinations of two or more of the systems described in our review: on-line tumor position and patient information should be combined with MLC position and linac output detection accuracy. In this way the effects of SBRT dose delivery errors will be reduced.
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Affiliation(s)
- Marco Esposito
- S.C. Fisica Sanitaria Firenze-Empoli, Azienda Sanitaria USL Toscana Centro, Italy.
| | | | - Sara Bresciani
- Medical Physics, Candiolo Cancer Institute - FPO IRCCS, Turin, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Maria Daniela Falco
- Department of Radiation Oncology "G. D'Annunzio", University of Chieti, SS. Annunziata Hospital, Chieti, Italy
| | - Cristina Garibaldi
- Radiation Research Unit, European Institute of Oncology IRCCS, Milan, Italy
| | - Serenella Russo
- S.C. Fisica Sanitaria Firenze-Empoli, Azienda Sanitaria USL Toscana Centro, Italy
| | - Cinzia Talamonti
- University of Florence, Dept Biomedical Experimental and Clinical Science, "Mario Serio", Medical Physics Unit, AOU Careggi, Florence, Italy
| | - Michele Stasi
- Medical Physics, Candiolo Cancer Institute - FPO IRCCS, Turin, Italy
| | - Pietro Mancosu
- Medical Physics Unit of Radiotherapy Dept., Humanitas Clinical and Research Hospital - IRCCS, Rozzano, Italy
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Kang S, Li J, Ma J, Zhang W, Liao X, Qing H, Tan T, Xin X, Tang B, Piermattei A, Orlandini LC. Evaluation of interfraction setup variations for postmastectomy radiation therapy using EPID-based in vivo dosimetry. J Appl Clin Med Phys 2019; 20:43-52. [PMID: 31541537 PMCID: PMC6806484 DOI: 10.1002/acm2.12712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 07/18/2019] [Accepted: 08/07/2019] [Indexed: 12/20/2022] Open
Abstract
Postmastectomy radiation therapy is technically difficult and can be considered one of the most complex techniques concerning patient setup reproducibility. Slight patient setup variations — particularly when high‐conformal treatment techniques are used — can adversely affect the accuracy of the delivered dose and the patient outcome. This research aims to investigate the inter‐fraction setup variations occurring in two different scenarios of clinical practice: at the reference and at the current patient setups, when an image‐guided system is used or not used, respectively. The results were used with the secondary aim of assessing the robustness of the patient setup procedure in use. Forty eight patients treated with volumetric modulated arc and intensity modulated therapies were included in this study. EPID‐based in vivo dosimetry (IVD) was performed at the reference setup concomitantly with the weekly cone beam computed tomography acquisition and during the daily current setup. Three indices were analyzed: the ratio R between the reconstructed and planned isocenter doses, γ% and the mean value of γ from a transit dosimetry based on a two‐dimensional γ‐analysis of the electronic portal images using 5% and 5 mm as dose difference and distance to agreement gamma criteria; they were considered in tolerance if R was within 5%, γ% > 90% and γmean < 0.4. One thousand and sixteen EPID‐based IVD were analyzed and 6.3% resulted out of the tolerance level. Setup errors represented the main cause of this off tolerance with an occurrence rate of 72.2%. The percentage of results out of tolerance obtained at the current setup was three times greater (9.5% vs 3.1%) than the one obtained at the reference setup, indicating weaknesses in the setup procedure. This study highlights an EPID‐based IVD system's utility in the radiotherapy routine as part of the patient’s treatment quality controls and to optimize (or confirm) the performed setup procedures’ accuracy.
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Affiliation(s)
- Shengwei Kang
- Key Laboratory of Radiation Physics and Technology, Institute of Nuclear Science and Technology, Sichuan University, Chengdu, China.,Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Chengdu, China
| | - Jie Li
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Chengdu, China
| | - Jiabao Ma
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Chengdu, China
| | - Wei Zhang
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Chengdu, China
| | - Xiongfei Liao
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Chengdu, China
| | - Hou Qing
- Institute of Nuclear Science and Technology, Sichuan University, Chengdu, China
| | - Tingqiang Tan
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Chengdu, China
| | - Xin Xin
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Chengdu, China
| | - Bin Tang
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Chengdu, China
| | - Angelo Piermattei
- UOC Fisica Sanitaria, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Lucia Clara Orlandini
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Chengdu, China
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