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Bolin MC, Falk M, Hedman M, Gagliardi G, Onjukka E. Surface-guided radiotherapy improves rotational accuracy in gynecological cancer patients. Rep Pract Oncol Radiother 2024; 28:764-771. [PMID: 38515814 PMCID: PMC10954265 DOI: 10.5603/rpor.98733] [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: 05/04/2023] [Accepted: 12/20/2023] [Indexed: 03/23/2024] Open
Abstract
Background The aim of this study was to determine if rotational uncertainties in gynecological cancer patients can be reduced using surface imaging (SI) compared to aligning three markers on the patient's skin with in-room lasers (marker-laser). Materials and methods Fifty gynecological cancer patients treated with external-beam radiotherapy were retrospectively analyzed; 25 patients were positioned with marker-laser and 25 patients were positioned with SI. The values of rotational (pitch and roll) deviations of the patient positions between the treatment-planning computed tomography (CT) and online cone-beam computed tomography (CBCT) were collected for both subcohorts and all treatment fractions after performing automatic registration between the two image sets. Statistical analysis of the difference between the two set-up methods was performed using the Mann-Whitney U-test. Results The median pitch deviation were 1.5° [interquartile range (IQR): 0.6°-2.6°] and 1.1° (IQR: 0.5°-1.9°) for the marker-laser and SI methods, respectively (p < 0.01). The median roll deviation was 0.5° (IQR: 0.2°-0.9°), and 0.7° (IQR: 0.3°-1.2°) for the marker-laser and SI methods, respectively (p < 0.01). Given the shape of the target, pitch deviations had a greater impact on the uncertainty at the periphery of the target and were considered more relevant. Conclusion By introducing SI as a set-up method in gynecological cancer patients, higher positioning accuracy could be achieved compared with the marker-laser set-up method. This was demonstrated based on residual deviations rather than deviations corrected for by image-guided radiotherapy (IGRT).
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Affiliation(s)
- Mimmi-Caroline Bolin
- Section of Radiotherapy and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marianne Falk
- Section of Radiotherapy and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mattias Hedman
- Department of Radiation Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Giovanna Gagliardi
- Section of Radiotherapy and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Eva Onjukka
- Section of Radiotherapy and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
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Schöpe M, Sahlmann J, Jaschik S, Findeisen A, Klautke G. 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; 200:60-70. [PMID: 37971534 DOI: 10.1007/s00066-023-02170-x] [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: 12/09/2022] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The objective of this work is to estimate the patient positioning accuracy of a surface-guided radiation therapy (SGRT) system using an optical surface scanner compared to an X‑ray-based imaging system (IGRT) with respect to their impact on intracranial stereotactic radiotherapy (SRT) and intracranial stereotactic radiosurgery (SRS). METHODS Patient positioning data, both acquired with SGRT and IGRT systems at the same linacs, serve as a basis for determination of positioning accuracy. A total of 35 patients with two different open face masks (578 datasets) were positioned using X‑ray stereoscopic imaging and the patient position inside the open face mask was recorded using SGRT. The measurement accuracy of the SGRT system (in a "standard" and an SRS mode with higher resolution) was evaluated using both IGRT and SGRT patient positioning datasets taking into account the measurement errors of the X‑ray system. Based on these clinically measured datasets, the positioning accuracy was estimated using Monte Carlo (MC) simulations. The relevant evaluation criterion, as standard of practice in cranial SRT, was the 95th percentile. RESULTS The interfractional measurement displacement vector of the SGRT system, σSGRT, in high resolution mode was estimated at 2.5 mm (68th percentile) and 5 mm (95th percentile). If the standard resolution was used, σSGRT increased by about 20%. The standard deviation of the axis-related σSGRT of the SGRT system ranged between 1.5 and 1.8 mm interfractionally and 0.5 and 1.0 mm intrafractionally. The magnitude of σSGRT is mainly due to the principle of patient surface scanning and not due to technical limitations or vendor-specific issues in software or hardware. Based on the resulting σSGRT, MC simulations served as a measure for the positioning accuracy for non-coplanar couch rotations. If an SGRT system is used as the only patient positioning device in non-coplanar fields, interfractional positioning errors of up to 6 mm and intrafractional errors of up to 5 mm cannot be ruled out. In contrast, MC simulations resulted in a positioning error of 1.6 mm (95th percentile) using the IGRT system. The cause of positioning errors in the SGRT system is mainly a change in the facial surface relative to a defined point in the brain. CONCLUSION In order to achieve the necessary geometric accuracy in cranial stereotactic radiotherapy, use of an X‑ray-based IGRT system, especially when treating with non-coplanar couch angles, is highly recommended.
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Affiliation(s)
- Michael Schöpe
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany
| | - Jacob Sahlmann
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany
| | - Stefan Jaschik
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany.
| | - Anne Findeisen
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany
| | - Gunther Klautke
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany
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Oku Y, Toyota M, Saigo Y. Characteristics of detection accuracy of the patient setup using InBore optical patient positioning system. Radiol Phys Technol 2023; 16:532-542. [PMID: 37812309 DOI: 10.1007/s12194-023-00741-2] [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: 06/16/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023]
Abstract
This study aimed to evaluate the detection accuracy of the AlignRT-InBore system in surface-guided radiation therapy using a phantom and to determine the feasibility of the system by conducting a comparative analysis with cone-beam computed tomography (CBCT) registration. The AlignRT-InBore system integrated with the ETHOS Therapy was used. A phantom and a QUASAR phantom were employed to examine the specific areas of interest relevant to clinical cases. The evaluation involved monitoring translations for approximately 30 min and assessing the position detection accuracy for static and moving objects. Fifty clinical cases were used to evaluate the position detection accuracy and its relationship with the localization accuracy of CBCT before treatment. The detection accuracy of static and moving objects was within 1.0 mm using the phantom. However, the longitudinal direction tended to be larger than the other directions. Regarding the accuracy of localization in clinical cases, a strong and statistically significant (p < 0.01) correlation was observed in each direction. A detection accuracy within 1.0 mm is possible for static and moving objects. The detection accuracy of the patient setup using the InBore optical patient positioning system was extremely high, and the patient could be detected with high precision, suggesting its usefulness.
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Affiliation(s)
- Yoshifumi Oku
- Division of Radiology, Department of Clinical Technology, Kagoshima University Hospital, 8-35-1, Sakuragaoka, Kagoshima-City, Kagoshima, 890-8520, Japan.
| | - Masahiko Toyota
- Division of Radiology, Department of Clinical Technology, Kagoshima University Hospital, 8-35-1, Sakuragaoka, Kagoshima-City, Kagoshima, 890-8520, Japan
| | - Yasumasa Saigo
- Division of Radiology, Department of Clinical Technology, Kagoshima University Hospital, 8-35-1, Sakuragaoka, Kagoshima-City, Kagoshima, 890-8520, Japan
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4
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Lai JL, Liu SP, Jiang XX, Liu J, Li A, Li B, Li XK, Ye XJ, Lei KJ, Zhou L. Can Optical Surface Imaging Replace Non-coplanar Cone-beam Computed Tomography for Non-coplanar Set-up Verification in Single-isocentre Non-coplanar Stereotactic Radiosurgery and Hypofractionated Stereotactic Radiotherapy for Single and Multiple Brain Metastases? Clin Oncol (R Coll Radiol) 2023; 35:e657-e665. [PMID: 37778972 DOI: 10.1016/j.clon.2023.09.007] [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: 03/30/2023] [Revised: 08/03/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
AIMS To conduct a direct comparison regarding the non-coplanar positioning accuracy between the optical surface imaging system Catalyst HDTM and non-coplanar cone-beam computed tomography (NC-CBCT) in intracranial single-isocentre non-coplanar stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (HSRT). MATERIALS AND METHODS Twenty patients with between one and five brain metastases who underwent single-isocentre non-coplanar volumetric modulated arc therapy (NC-VMAT) SRS or HSRT were enrolled in this study. For each non-zero couch angle, both Catalyst HDTM and NC-CBCT were used for set-up verification prior to beam delivery. The set-up error reported by Catalyst HDTM was compared with the set-up error derived from NC-CBCT, which was defined as the gold standard. Additionally, the dose delivery accuracy of each non-coplanar field after using Catalyst HDTM and NC-CBCT for set-up correction was measured with SRS MapCHECKTM. RESULTS The median set-up error differences (absolute values) between the two positioning methods were 0.30 mm, 0.40 mm, 0.50 mm, 0.15°, 0.10° and 0.10° in the vertical, longitudinal, lateral, yaw, pitch and roll directions, respectively. The largest absolute set-up error differences regarding translation and rotation were 1.5 mm and 1.1°, which occurred in the longitudinal and yaw directions, respectively. Only 35.71% of the pairs of measurements were within the tolerance of 0.5 mm and 0.5° simultaneously. In addition, the non-coplanar field with NC-CBCT correction yielded a higher gamma passing rate than that with Catalyst HDTM correction (P < 0.05), especially for evaluation criteria of 1%/1 mm with a median increase of 12.8%. CONCLUSIONS Catalyst HDTM may not replace NC-CBCT for non-coplanar set-up corrections in single-isocentre NC-VMAT SRS and HSRT for single and multiple brain metastases. The potential role of Catalyst HDTM in intracranial SRS/HSRT needs to be further studied in the future.
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Affiliation(s)
- J L Lai
- Radiotherapy Physics & Technology Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - S P Liu
- Radiotherapy Physics & Technology Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - X X Jiang
- Radiotherapy Physics & Technology Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - J Liu
- Department of Oncology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - A Li
- Radiotherapy Physics & Technology Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - B Li
- Radiotherapy Physics & Technology Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - X K Li
- West China Clinical Medical College of Sichuan University, Chengdu, Sichuan, China
| | - X J Ye
- Department of Oncology, Yibin Second People's Hospital, Yibin, Sichuan, China
| | - K J Lei
- Department of Oncology, Yibin Second People's Hospital, Yibin, Sichuan, China
| | - L Zhou
- Thoracic Oncology Ward, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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Psarras M, Stasinou D, Stroubinis T, Protopapa M, Zygogianni A, Kouloulias V, Platoni K. Surface-Guided Radiotherapy: Can We Move on from the Era of Three-Point Markers to the New Era of Thousands of Points? Bioengineering (Basel) 2023; 10:1202. [PMID: 37892932 PMCID: PMC10604452 DOI: 10.3390/bioengineering10101202] [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: 09/06/2023] [Revised: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
The surface-guided radiotherapy (SGRT) technique improves patient positioning with submillimeter accuracy compared with the conventional positioning technique of lasers using three-point tattoos. SGRT provides solutions to considerations that arise from the conventional setup technique, such as variability in tattoo position and the psychological impact of the tattoos. Moreover, SGRT provides monitoring of intrafractional motion. PURPOSE This literature review covers the basics of SGRT systems and examines whether SGRT can replace the traditional positioning technique. In addition, it investigates SGRT's potential in reducing positioning times, factors affecting SGRT accuracy, the effectiveness of live monitoring, and the impact on patient dosage. MATERIALS AND METHODS This study focused on papers published from 2016 onward that compared SGRT with the traditional positioning technique and investigated factors affecting SGRT accuracy and effectiveness. RESULTS/CONCLUSIONS SGRT provides the same or better results regarding patient positioning. The implementation of SGRT can reduce overall treatment time. It is an effective technique for detecting intrafraction patient motion, improving treatment accuracy and precision, and creating a safe and comfortable environment for the patient during treatment.
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Affiliation(s)
- Michalis Psarras
- Medical Physics Unit, 2nd Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
| | - Despoina Stasinou
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
| | - Theodoros Stroubinis
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
| | - Maria Protopapa
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
| | - Anna Zygogianni
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Vassilis Kouloulias
- Radiation Oncology Unit, 2nd Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Kalliopi Platoni
- Medical Physics Unit, 2nd Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
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Rudat V, Shi Y, Zhao R, Xu S, Yu W. Setup accuracy and margins for surface-guided radiotherapy (SGRT) of head, thorax, abdomen, and pelvic target volumes. Sci Rep 2023; 13:17018. [PMID: 37813917 PMCID: PMC10562432 DOI: 10.1038/s41598-023-44320-2] [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: 07/04/2022] [Accepted: 10/06/2023] [Indexed: 10/11/2023] Open
Abstract
The goal of the study was to evaluate the inter- and intrafractional patient setup accuracy of target volumes located in the head, thoracic, abdominal, and pelvic regions when using SGRT, by comparing it with that of laser alignment using patient skin marks, and to calculate the corresponding setup margins. A total of 2303 radiotherapy fractions of 183 patients were analyzed. All patients received daily kilovoltage cone-beam computed tomography scans (kV-CBCT) for online verification. From November 2019 until September 2020, patient setup was performed using laser alignment with patient skin marks, and since October 2020, using SGRT. The setup accuracy was measured by the six degrees of freedom (6DOF) corrections based on the kV-CBCT. The corresponding setup margins were calculated using the van Herk formula. Analysis of variance (ANOVA) was used to evaluate the impact of multiple factors on the setup accuracy. The inter-fractional patient setup accuracy was significantly better using SGRT compared to laser alignment with skin marks. The mean three-dimensional vector of the translational setup deviation of tumors located in the thorax, abdomen, and pelvis using SGRT was 3.6 mm (95% confidence interval (CI) 3.3 mm to 3.9 mm) and 4.5 mm using laser alignment with skin marks (95% CI 3.9 mm to 5.2 mm; p = 0.001). Calculation of setup margins for the combined inter- and intra-fractional setup error revealed similar setup margins using SGRT and kV-CBCT once a week compared to laser alignment with skin marks and kV-CBCT every other day. Furthermore, comparable setup margins were found for open-face thermoplastic masks with AlignRT compared to closed-face thermoplastic masks with laser alignment and mask marks. SGRT opens the possibility to reduce the number of CBCTs while maintaining sufficient setup accuracy. The advantage is a reduction of imaging dose and overall treatment time. Open-face thermoplastic masks may be used instead of closed-face thermoplastic masks to increase the patient's comfort.
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Affiliation(s)
- Volker Rudat
- Department of Radiation Oncology, Jiahui International Cancer Center Shanghai, Jiahui Health, Shanghai, China.
| | - Yanyan Shi
- Department of Radiation Oncology, Jiahui International Cancer Center Shanghai, Jiahui Health, Shanghai, China
| | - Ruping Zhao
- Department of Radiation Oncology, Jiahui International Cancer Center Shanghai, Jiahui Health, Shanghai, China
| | - Shuyin Xu
- Department of Radiation Oncology, Jiahui International Cancer Center Shanghai, Jiahui Health, Shanghai, China
| | - Wei Yu
- Department of Radiation Oncology, Jiahui International Cancer Center Shanghai, Jiahui Health, Shanghai, China
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Mannerberg A, Konradsson E, Kügele M, Edvardsson A, Kadhim M, Ceberg C, Peterson K, Thomasson HM, Arendt ML, Børresen B, Jensen KB, Ceberg S. Surface guided electron FLASH radiotherapy for canine cancer patients. Med Phys 2023. [PMID: 37190907 DOI: 10.1002/mp.16453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/05/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND During recent years FLASH radiotherapy (FLASH-RT) has shown promising results in radiation oncology, with the potential to spare normal tissue while maintaining the antitumor effects. The high speed of the FLASH-RT delivery increases the need for fast and precise motion monitoring to avoid underdosing the target. Surface guided radiotherapy (SGRT) uses surface imaging (SI) to render a 3D surface of the patient. SI provides real-time motion monitoring and has a large scanning field of view, covering off-isocentric positions. However, SI has so far only been used for human patients with conventional setup and treatment. PURPOSE The aim of this study was to investigate the performance of SI as a motion management tool during electron FLASH-RT of canine cancer patients. METHODS To evaluate the SI system's ability to render surfaces of fur, three fur-like blankets in white, grey, and black were used to imitate the surface of canine patients and the camera settings were optimized for each blanket. Phantom measurements using the fur blankets were carried out, simulating respiratory motion and sudden shift. Respiratory motion was simulated using the QUASAR Respiratory Motion Phantom with the fur blankets placed on the phantom platform, which moved 10 mm vertically with a simulated respiratory period of 4 s. Sudden motion was simulated with an in-house developed phantom, consisting of a platform which was moved vertically in a stepwise motion at a chosen frequency. For sudden measurements, 1, 2, 3, 4, 5, 6, 7, and 10 Hz were measured. All measurements were both carried out at the conventional source-to-surface distance (SSD) of 100 cm, and in the locally used FLASH-RT setup at SSD = 70 cm. The capability of the SI system to reproduce the simulated motion and the sampling time were evaluated. As an initial step towards clinical implementation, the feasibility of SI for surface guided FLASH-RT was evaluated for 11 canine cancer patients. RESULTS The SI camera was capable of rendering surfaces for all blankets. The deviation between simulated and measured mean peak-to-peak breathing amplitude was within 0.6 mm for all blankets. The sampling time was generally higher for the black fur than for the white and grey fur, for the measurement of both respiratory and sudden motion. The SI system could measure sudden motion within 62.5 ms and detect motion with a frequency of 10 Hz. The feasibility study of the canine patients showed that the SI system could be an important tool to ensure patient safety. By using this system we could ensure and document that 10 out of 11 canine patients had a total vector offset from the reference setup position <2 mm immediately before and after irradiation. CONCLUSIONS We have shown that SI can be used for surface guided FLASH-RT of canine patients. The SI system is currently not fast enough to interrupt a FLASH-RT beam while irradiating but with the short sampling time sudden motion can be detected. The beam can therefore be held just prior to irradiation, preventing treatment errors such as underdosing the target.
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Affiliation(s)
| | | | - Malin Kügele
- Medical Radiation Physics, Lund University, Lund, Sweden
- Department of Hematology- Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Anneli Edvardsson
- Medical Radiation Physics, Lund University, Lund, Sweden
- Department of Hematology- Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Mustafa Kadhim
- Department of Hematology- Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Crister Ceberg
- Medical Radiation Physics, Lund University, Lund, Sweden
| | - Kristoffer Peterson
- Department of Hematology- Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Department of Oncology, MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Hanna-Maria Thomasson
- Department of Hematology- Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Maja L Arendt
- Department of Veterinary Clinical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Betina Børresen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | | | - Sofie Ceberg
- Medical Radiation Physics, Lund University, Lund, Sweden
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Dekker J, Essers M, Verheij M, Kusters M, de Kruijf W. Dose coverage and breath-hold analysis of breast cancer patients treated with surface-guided radiotherapy. Radiat Oncol 2023; 18:72. [PMID: 37081477 PMCID: PMC10116713 DOI: 10.1186/s13014-023-02261-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/10/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Surface-guided radiotherapy (SGRT) is used to ensure a reproducible patient set-up and for intra-fraction motion monitoring. The arm position of breast cancer patients is important, since this is related to the position of the surrounding lymph nodes. The aim of the study was to investigate the set-up accuracy of the arm of patients positioned using SGRT. Moreover, the actual delivered dose was investigated and an extensive breath-hold analysis was performed. METHODS 84 patients who received local or locoregional breast radiation therapy were positioned and monitored using SGRT. The accuracy of the arm position, represented by the clavicle position, was studied on the anterior-posterior kV-image. To investigate the effect of changes in anatomy and patient set-up, the actual delivered dose was calculated on cone-beam CT-scans (CBCT). A deformable registration of the CT to the CBCT was applied to deform the structures of the CT onto the CBCT. The minimum dose in percentage of the prescribed dose that was received by 98% of different CTV volumes (D98) was determined. An extensive breath-hold analysis was performed and definitions for relevant parameters were given. RESULTS The arm position of 77 out of 84 patients in total was successful, based on the clavicle rotation. The mean clavicle rotation was 0.4° (± 2.0°). For 89.8% of the patients who were irradiated on the whole-breast D98 was larger than 95% of the prescribed dose (D98 > 95%). D98 > 95% applied for 70.8% of the patients irradiated on the chest wall. Concerning the lymph node CTVs, D98 > 95% for at least 95% of the patients. The breath-hold analysis showed a mean residual setup error of - 0.015 (± 0.90), - 0.18 (± 0.82), - 0.58 (± 1.1) mm in vertical, lateral, and longitudinal direction, respectively. The reproducibility and stability of the breath-hold was good, with median 0.60 mm (95% confidence interval (CI) [0.66-0.71] mm) and 0.20 mm (95% CI 0.21-0.23] mm), respectively. CONCLUSIONS Using SGRT we were able to position breast cancer patients successfully, with focus on the arm position. The actual delivered dose calculated on the CBCT was adequate and no relation between clavicle rotation and actual delivered dose was found. Moreover, breath-hold analysis showed a good reproducibility and stability of the breath-hold. Trial registration CCMO register NL69214.028.19.
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Affiliation(s)
- Janita Dekker
- Instituut Verbeeten, Klinische fysica & instrumentatie, Postbus 90120, 5000 LA, Tilburg, The Netherlands.
| | - Marion Essers
- Instituut Verbeeten, Klinische fysica & instrumentatie, Postbus 90120, 5000 LA, Tilburg, The Netherlands
| | - Marcel Verheij
- Department of Radiation Oncology, Radboud University Medical Center, Geert Grooteplein 32, 6525 GA, Nijmegen, The Netherlands
| | - Martijn Kusters
- Department of Radiation Oncology, Radboud University Medical Center, Geert Grooteplein 32, 6525 GA, Nijmegen, The Netherlands
| | - Willy de Kruijf
- Instituut Verbeeten, Klinische fysica & instrumentatie, Postbus 90120, 5000 LA, Tilburg, The Netherlands
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Zhao H, Paxton A, Sarkar V, Price RG, Huang J, Su FCF, Li X, Rassiah P, Szegedi M, Salter B. Surface-Guided Patient Setup Versus Traditional Tattoo Markers for Radiation Therapy: Is Tattoo-Less Setup Feasible for Thorax, Abdomen and Pelvis Treatment? Cureus 2022; 14:e28644. [PMID: 36196310 PMCID: PMC9525098 DOI: 10.7759/cureus.28644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose: In this study, patient setup accuracy was compared between surface guidance and tattoo markers for radiation therapy treatment sites of the thorax, abdomen and pelvis. Methods and materials: A total of 608 setups performed on 59 patients using both surface-guided and tattoo-based patient setups were analyzed. During treatment setup, patients were aligned to room lasers using their tattoos, and then the six-degree-of-freedom (6DOF) surface-guided offsets were calculated and recorded using AlignRT system. While the patient remained in the same post-tattoo setup position, target localization imaging (radiographic or ultrasound) was performed and these image-guided shifts were recorded. Finally, surface-guided vs tattoo-based offsets were compared to the final treatment position (based on radiographic or ultrasound imaging) to evaluate the accuracy of the two setup methods. Results: The overall average offsets of tattoo-based and surface-guidance-based patient setups were comparable within 3.2 mm in three principal directions, with offsets from tattoo-based setups being slightly less. The maximum offset for tattoo setups was 2.2 cm vs. 4.3 cm for surface-guidance setups. Larger offsets (ranging from 2.0 to 4.3 cm) were observed for surface-guided setups in 14/608 setups (2.3%). For these same cases, the maximum observed tattoo-based offset was 0.7 cm. Of the cases with larger surface-guided offsets, 13/14 were for abdominal/pelvic treatment sites. Additionally, larger rotations (>3°) were recorded in 18.6% of surface-guided setups. The majority of these larger rotations were observed for abdominal and pelvic sites (~84%). Conclusions: The small average differences observed between tattoo-based and surface-guidance-based patient setups confirm the general equivalence of the two potential methods, and the feasibility of tattoo-less patient setup. However, a significant number of larger surface-guided offsets (translational and rotational) were observed, especially in the abdominal and pelvic regions. These cases should be anticipated and contingency setup methods planned for.
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10
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Sato K, Kanai T, Lee SH, Miyasaka Y, Chai H, Souda H, Iwai T, Sato R, Goto N, Kawamura T. Development of a quantitative analysis method for assessing patient body surface deformation using an optical surface tracking system. Radiol Phys Technol 2022; 15:367-378. [PMID: 36040622 DOI: 10.1007/s12194-022-00676-0] [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: 03/06/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022]
Abstract
This study aimed to develop a new method to quantitatively analyze body shape changes in patients during radiotherapy without additional radiation exposure using an optical surface tracking system. This method's accuracy was evaluated using a cubic phantom with a known shift. Surface images of three-dimensionally printed phantoms, which simulated the head and neck shapes of real patients before and after treatment, were used to create a deformation surface area histogram. The near-maximum deformation value covering an area of 2 cm2 in the surface image (Def-2cm2) was calculated. A volumetric modulated arc therapy (VMAT) plan was also created on the pre-treatment phantom, and the dose distribution was recalculated on the post-treatment phantom to compare the dose indices. Surface images of four patients were analyzed to evaluate Def-2cm2 and examine whether this method can be used in clinical cases. Experiments with the cubic phantom resulted in a mean deformation error of 0.08 mm. With head and neck phantoms, the Def-2cm2 value was 17.5 mm, and the dose that covered 95% of the planning target volume in the VMAT plan decreased by 11.7%, indicating that deformation of the body surface may affect the dose distribution. Although analysis of the clinical data showed no clinically relevant deformation in any of the cases, slight skin sagging and respiratory changes in the body surface were observed. The proposed method can quantitatively and accurately evaluate the deformation of a body surface. This method is expected to be used to make decisions regarding modifications to treatment plans.
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Affiliation(s)
- Kimihiko Sato
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan
- Department of Radiology, Nihonkai General Hospital, 30 Akiho-chou, Sakata, Yamagata, 998-8501, Japan
| | - Takayuki Kanai
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan.
| | - Sung Hyun Lee
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan
| | - Yuya Miyasaka
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan
| | - Hongbo Chai
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan
| | - Hikaru Souda
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan
| | - Takeo Iwai
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan
| | - Ryuji Sato
- Department of Radiology, Nihonkai General Hospital, 30 Akiho-chou, Sakata, Yamagata, 998-8501, Japan
| | - Naoki Goto
- Department of Radiology, Nihonkai General Hospital, 30 Akiho-chou, Sakata, Yamagata, 998-8501, Japan
| | - Tsukasa Kawamura
- Department of Radiology, Nihonkai General Hospital, 30 Akiho-chou, Sakata, Yamagata, 998-8501, Japan
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11
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Da Silva Mendes V, Reiner M, Huang L, Reitz D, Straub K, Corradini S, Niyazi M, Belka C, Kurz C, Landry G, Freislederer P. ExacTrac Dynamic workflow evaluation: Combined surface optical/thermal imaging and X-ray positioning. J Appl Clin Med Phys 2022; 23:e13754. [PMID: 36001389 DOI: 10.1002/acm2.13754] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 07/07/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022] Open
Abstract
In modern radiotherapy (RT), especially for stereotactic radiotherapy or stereotactic radiosurgery treatments, image guidance is essential. Recently, the ExacTrac Dynamic (EXTD) system, a new combined surface-guided RT and image-guided RT (IGRT) system for patient positioning, monitoring, and tumor targeting, was introduced in clinical practice. The purpose of this study was to provide more information about the geometric accuracy of EXTD and its workflow in a clinical environment. The surface optical/thermal- and the stereoscopic X-ray imaging positioning systems of EXTD was evaluated and compared to cone-beam computed tomography (CBCT). Additionally, the congruence with the radiation isocenter was tested. A Winston Lutz test was executed several times over 1 year, and repeated end-to-end positioning tests were performed. The magnitude of the displacements between all systems, CBCT, stereoscopic X-ray, optical-surface imaging, and MV portal imaging was within the submillimeter range, suggesting that the image guidance provided by EXTD is accurate at any couch angle. Additionally, results from the evaluation of 14 patients with intracranial tumors treated with open-face masks are reported, and limited differences with a maximum of 0.02 mm between optical/thermal- and stereoscopic X-ray imaging were found. As the optical/thermal positioning system showed a comparable accuracy to other IGRT systems, and due to its constant monitoring capability, it can be an efficient tool for detecting intra-fractional motion and for real-time tracking of the surface position during RT.
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Affiliation(s)
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Lili Huang
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Reitz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Katrin Straub
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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12
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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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13
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Kutbi M, Peng KC, Wu Z. Zero-Shot Deep Domain Adaptation With Common Representation Learning. IEEE TRANSACTIONS ON PATTERN ANALYSIS AND MACHINE INTELLIGENCE 2022; 44:3909-3924. [PMID: 33621167 DOI: 10.1109/tpami.2021.3061204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Domain Adaptation aims at adapting the knowledge learned from a domain (source-domain) to another (target-domain). Existing approaches typically require a portion of task-relevant target-domain data a priori. We propose an approach, zero-shot deep domain adaptation (ZDDA), which uses paired dual-domain task-irrelevant data to eliminate the need for task-relevant target-domain training data. ZDDA learns to generate common representations for source and target domains data. Then, either domain representation is used later to train a system that works on both domains or having the ability to eliminate the need to either domain in sensor fusion settings. Two variants of ZDDA have been developed: ZDDA for classification task (ZDDA-C) and ZDDA for metric learning task (ZDDA-ML). Another limitation in Existing approaches is that most of them are designed for the closed-set classification task, i.e., the sets of classes in both the source and target domains are "known." However, ZDDA-C is also applicable to the open-set classification task where not all classes are "known" during training. Moreover, the effectiveness of ZDDA-ML shows ZDDA's applicability is not limited to classification tasks. ZDDA-C and ZDDA-ML are tested on classification and metric-learning tasks, respectively. Under most experimental conditions, ZDDA outperforms the baseline without using task-relevant target-domain-training data.
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14
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Batista V, Gober M, Moura F, Webster A, Oellers M, Ramtohul M, Kügele M, Freislederer P, Buschmann M, Anastasi G, Steiner E, Al-Hallaq H, Lehmann J. Surface guided radiation therapy: An international survey on current clinical practice. Tech Innov Patient Support Radiat Oncol 2022; 22:1-8. [PMID: 35402740 PMCID: PMC8984757 DOI: 10.1016/j.tipsro.2022.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022] Open
Abstract
Introduction Surface Guided Radiation Therapy (SGRT) is being increasingly implemented into clinical practice across a number of techniques and irradiation-sites. This technology, which is provided by different vendors, can be used with most simulation- and delivery-systems. However, limited guidelines and the complexity of clinical settings have led to diverse patterns of operation. With the aim to understand current clinical practice a survey was designed focusing on specifics of the clinical implementation and usage. Materials and methods A 32-question survey covered: type and number of systems, quality assurance (QA), clinical workflows, and identification of strengths/limitations. Respondents from different professional groups and countries were invited to participate. The survey was distributed internationally via ESTRO-membership, social media and vendors. Results Of the 278 institutions responding, 172 had at least one SGRT-system and 136 use SGRT clinically. Implementation and QA were primarily based on the vendors' recommendations and phantoms. SGRT was mainly implemented in breast RT (116/136), with strong but diverse representation of other sites. Many (58/135) reported at least partial elimination of skin-marks and a third (43/126) used open-masks. The most common imaging protocol reported included the combination of radiographic imaging with SGRT. Patient positioning (115/136), motion management (104/136) and DIBH (99/136) were the main applications.Main barriers to broader application were cost, system integration issues and lack of demonstrated clinical value. A lack of guidelines in terms of QA of the system was highlighted. Conclusions This overview of the SGRT status has the potential to support users, vendors and organisations in the development of practices, products and guidelines.
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Affiliation(s)
- V Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg, Germany
| | - M Gober
- Department of Radiation Oncology, Medical University of Vienna, Austria.,Institute for Radiation Oncology and Radiotherapy, Landesklinikum Wiener Neustadt, Austria
| | - F Moura
- Hospital CUF Descobertas, Department of Radiation Oncology, Lisbon, Portugal
| | - A Webster
- Radiotherapy and Proton Beam Therapy, University College Hospital, London, United Kingdom
| | - M Oellers
- MAASTRO Clinic, Department of Medical Physics, Maastricht, the Netherlands
| | - M Ramtohul
- Department of Medical Physics, Queen Elizabeth Hospital, University Hospitals Birmingham
| | - M Kügele
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Medical Radiation Physics, Lund University, Lund, Sweden
| | - P Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - M Buschmann
- Department of Radiation Oncology, Medical University of Vienna, Austria
| | - G Anastasi
- St. Luke's Cancer Centre, Royal Surrey Foundation Trust, Radiotherapy Physics, United Kingdom
| | - E Steiner
- Institute for Radiation Oncology and Radiotherapy, Landesklinikum Wiener Neustadt, Austria
| | - H Al-Hallaq
- Department of Radiation and Cellular Oncology, University of Chicago, USA
| | - J Lehmann
- Radiation Oncology Department, Calvary Mater Newcastle, Australia.,School of Information and Physical Sciences, University of Newcastle, Callaghan, Australia.,Institute of Medical Physics, University of Sydney, Australia
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15
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Freislederer P, Batista V, Öllers M, Buschmann M, Steiner E, Kügele M, Fracchiolla F, Corradini S, de Smet M, Moura F, Perryck S, Dionisi F, Nguyen D, Bert C, Lehmann J. ESTRO-ACROP guideline on surface guided radiation therapy. Radiother Oncol 2022; 173:188-196. [PMID: 35661677 DOI: 10.1016/j.radonc.2022.05.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
Abstract
Surface guidance systems enable patient positioning and motion monitoring without using ionising radiation. Surface Guided Radiation Therapy (SGRT) has therefore been widely adopted in radiation therapy in recent years, but guidelines on workflows and specific quality assurance (QA) are lacking. This ESTRO-ACROP guideline aims to give recommendations concerning SGRT roles and responsibilities and highlights common challenges and potential errors. Comprehensive guidelines for procurement, acceptance, commissioning, and QA of SGRT systems installed on computed tomography (CT) simulators, C-arm linacs, closed-bore linacs, and particle therapy treatment systems are presented that will help move to a consensus among SGRT users and facilitate a safe and efficient implementation and clinical application of SGRT.
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Affiliation(s)
- P Freislederer
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany.
| | - V Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - M Öllers
- Department of Radiotherapy, MAASTRO, Maastricht, The Netherlands
| | - M Buschmann
- Department of Radiation Oncology, Medical University of Vienna/AKH Wien, Austria
| | - E Steiner
- Institute for Radiation Oncology and Radiotherapy, Landesklinikum Wiener Neustadt, Austria
| | - M Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - F Fracchiolla
- Azienda Provinciale per i Servizi Sanitari (APSS) Protontherapy Department, Trento, Italy
| | - S Corradini
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany
| | - M de Smet
- Department of Medical Physics & Instrumentation, Institute Verbeeten, Tilburg, The Netherlands
| | - F Moura
- Hospital CUF Descobertas, Department of Radiation Oncology, Lisbon, Portugal
| | - S Perryck
- Department of Radiation Oncology, University Hospital Zürich, Switzerland
| | - F Dionisi
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - D Nguyen
- Centre de Radiothérapie de Mâcon, France
| | - C Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - J Lehmann
- Radiation Oncology Department, Calvary Mater Newcastle, Australia; School of Information and Physical Sciences, University of Newcastle, Australia; Institute of Medical Physics, University of Sydney, Australia
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16
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Saito M, Ueda K, Suzuki H, Komiyama T, Marino K, Aoki S, Sano N, Onishi H. Evaluation of the detection accuracy of set-up for various treatment sites using surface-guided radiotherapy system, VOXELAN: a phantom study. JOURNAL OF RADIATION RESEARCH 2022; 63:435-442. [PMID: 35467750 PMCID: PMC9124621 DOI: 10.1093/jrr/rrac015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/31/2022] [Indexed: 06/01/2023]
Abstract
The purpose of this study is to evaluate the detection accuracy of a 3-dimensional (3D) body scanner, VOXELAN, in surface-guided radiotherapy (SGRT) of each part of the human body using a whole-body human phantom. We used A Resusci Anne was used as the whole-body phantom. The detection accuracy of VOXELAN in a radiotherapy treatment room with a linear accelerator (LINAC) was evaluated for two reference images: reconstruction of the planning computed tomography (CT) image (CT reference) and scanning by VOXELAN before the treatment (scan reference). The accuracy of the translational and rotational directions was verified for four treatment sites (open face shell, breast, abdomen, and arm), using the magnitude of the 6D robotic couch movement as the true value. Our results showed that the detection accuracy improved as the displacement from the reference position decreased for all the sites. Using the scan reference, the average accuracy of the translational and rotational axes was within 1.44 mm and 0.41°, respectively, for all sites except the arms. Similarly, using the CT reference, the average accuracy was within 2.45 mm and 1.35°, respectively. Additionally, it was difficult for both reference images to recognize misalignment of the arms. In conclusion we discovered that VOXELAN achieved a high detection accuracy for the head with an open face shell, chest, and abdomen, indicating that the system is useful in a clinical setting. However, it is necessary to pay attention to location matching for areas with few features, such as surface irregularities and potential errors, when the reference image is created from CT.
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Affiliation(s)
- Masahide Saito
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Koji Ueda
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Hidekazu Suzuki
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Takafumi Komiyama
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Kan Marino
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Shinichi Aoki
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Naoki Sano
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
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17
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Jiang P, Liu Z, Jiang W, Qu A, Sun H, Wang J. Detection of setup errors with a body-surface laser-scanning system for whole-breast irradiation after breast-conserving surgery. J Appl Clin Med Phys 2022; 23:e13578. [PMID: 35293667 PMCID: PMC9121044 DOI: 10.1002/acm2.13578] [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: 11/19/2020] [Revised: 12/23/2022] [Accepted: 02/15/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE We compared the setup errors determined by an optical imaging system (OSIS) in women who received breast-conserving surgery (BCS) followed by whole-breast radiotherapy (WBRT) with those from cone-beam computed tomography (CBCT) carried out routinely. METHODS We compared 130 setup errors in 10 patients undergoing WBRT following BCS by analyzing the translational and rotational couch shifts via CBCT and OSIS. Patients were treated with intensity-modulated radiotherapy (IMRT). The patient outline extracted from the planning reference Computed tomography (CT) was used as the reference for OSIS and CBCT alignment during treatment. We detected the setup uncertainty using CBCT and OSIS at the first five fractionations of RT and then twice a week. RESULTS The absolute translational setup error (mean ± Standard deviation (SD)) in x (lateral), y (longitudinal), and z (vertical) axes detected by the OSIS was 0.14 ± 0.18, 0.15 ± 0.14, and 0.13 ± 0.13 cm, respectively. The rotational setup error (mean ± SD) in Rx (pitch), Ry (roll), and Rz (yaw) axes was 0.77 ± 0.54, 0.76 ± 0.61, and 1.23 ± 0.95, respectively. Significant difference is observed only in one direction (Rx, p = 0.03) in the paired setup errors obtaining from OSIS and CBCT, without significant differences in five directions. CONCLUSION OSIS is a repeatable and reliable system that can be used to detect misalignments with accuracy, which is capable of supplementing CBCT for WBRT after BCS. We believe that an OSIS may be easier to use, quicker, and reduce overall dose as this method of patient alignment does not require ionizing radiation.
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Affiliation(s)
- Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ziyi Liu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Weijuan Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ang Qu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
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18
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Pakela JM, Knopf A, Dong L, Rucinski A, Zou W. Management of Motion and Anatomical Variations in Charged Particle Therapy: Past, Present, and Into the Future. Front Oncol 2022; 12:806153. [PMID: 35356213 PMCID: PMC8959592 DOI: 10.3389/fonc.2022.806153] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/04/2022] [Indexed: 12/14/2022] Open
Abstract
The major aim of radiation therapy is to provide curative or palliative treatment to cancerous malignancies while minimizing damage to healthy tissues. Charged particle radiotherapy utilizing carbon ions or protons is uniquely suited for this task due to its ability to achieve highly conformal dose distributions around the tumor volume. For these treatment modalities, uncertainties in the localization of patient anatomy due to inter- and intra-fractional motion present a heightened risk of undesired dose delivery. A diverse range of mitigation strategies have been developed and clinically implemented in various disease sites to monitor and correct for patient motion, but much work remains. This review provides an overview of current clinical practices for inter and intra-fractional motion management in charged particle therapy, including motion control, current imaging and motion tracking modalities, as well as treatment planning and delivery techniques. We also cover progress to date on emerging technologies including particle-based radiography imaging, novel treatment delivery methods such as tumor tracking and FLASH, and artificial intelligence and discuss their potential impact towards improving or increasing the challenge of motion mitigation in charged particle therapy.
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Affiliation(s)
- Julia M. Pakela
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Antje Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Antoni Rucinski
- Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
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19
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Kadman B, Takemura A, Ito T, Okada N, Kojima H, Ueda S. Accuracy of patient setup positioning using surface‐guided radiotherapy with deformable registration in cases of surface deformation. J Appl Clin Med Phys 2022; 23:e13493. [PMID: 35077004 PMCID: PMC9398221 DOI: 10.1002/acm2.13493] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
The Catalyst™ HD (C‐RAD Positioning AB, Uppsala, Sweden) is surface‐guided radiotherapy (SGRT) equipment that adopts a deformable model. The challenge in applying the SGRT system is accurately correcting the setup error using a deformable model when the body of the patient is deformed. This study evaluated the effect of breast deformation on the accuracy of the setup correction of the SGRT system. Physical breast phantoms were used to investigate the relationship between the mean deviation setup error obtained from the SGRT system and the breast deformation. Physical breast phantoms were used to simulate extension and shrinkage deformation (−30 to 30 mm) by changing breast pieces. Three‐dimensional (3D) Slicer software was used to evaluate the deformation. The maximum deformations in X, Y, and Z directions were obtained as the differences between the original and deformed breasts. We collected the mean deviation setup error from the SGRT system by replacing the original breast part with the deformed breast part. The mean absolute difference of lateral, longitudinal, vertical, pitch, roll, and yaw, between the rigid and deformable registrations was 2.4 ± 1.7 mm, 1.3 ± 1.2 mm, 6.4 ± 5.2 mm, 2.5° ± 2.5°, 2.2° ± 2.4°, and 1.0° ± 1.0°, respectively. Deformation in the Y direction had the best correlation with the mean deviation translation error (R = 0.949) and rotation error (R = 0.832). As the magnitude of breast deformation increased, both mean deviation setup errors increased, and there was greater error in translation than in rotation. Large deformation of the breast surface affects the setup correction. Deformation in the Y direction most affects translation and rotation errors.
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Affiliation(s)
- Boriphat Kadman
- Division of Health Sciences Graduate School of Medical Sciences, Pharmaceutical and Health Sciences Kanazawa University 5‐11‐80 Kodatsuno Kanazawa Ishikawa 9200942 Japan
| | - Akihiro Takemura
- Faculty of Health Sciences Institute of Medical, Pharmaceutical and Health Sciences Kanazawa University 5‐11‐80 Kodatsuno Kanazawa Ishikawa 9200942 Japan
| | - Tatsuya Ito
- Department of Radiological Technology Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital 2‐9 Myouke‐cho, Showa‐ku Nagoya Aichi 4668650 Japan
| | - Naoki Okada
- Division of Health Sciences Graduate School of Medical Sciences, Pharmaceutical and Health Sciences Kanazawa University 5‐11‐80 Kodatsuno Kanazawa Ishikawa 9200942 Japan
| | - Hironori Kojima
- Department of Radiology Kanazawa University Hospital 13‐1 Takara‐machi Kanazawa Ishikawa 9208641 Japan
| | - Shinichi Ueda
- Department of Radiology Kanazawa University Hospital 13‐1 Takara‐machi Kanazawa Ishikawa 9208641 Japan
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20
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Rahman M, Bruza P, Hachadorian R, Alexander D, Cao X, Zhang R, Gladstone DJ, Pogue BW. Optimization of in vivo Cherenkov imaging dosimetry via spectral choices for ambient background lights and filtering. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210195RR. [PMID: 34643072 PMCID: PMC8510878 DOI: 10.1117/1.jbo.26.10.106003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
SIGNIFICANCE The Cherenkov emission spectrum overlaps with that of ambient room light sources. Choice of room lighting devices dramatically affects the efficient detection of Cherenkov emission during patient treatment. AIM To determine optimal room light sources allowing Cherenkov emission imaging in normally lit radiotherapy treatment delivery rooms. APPROACH A variety of commercial light sources and long-pass (LP) filters were surveyed for spectral band separation from the red to near-infrared Cherenkov light emitted by tissue. Their effects on signal-to-noise ratio (SNR), Cherenkov to background signal ratio, and image artifacts were quantified by imaging irradiated tissue equivalent phantoms with an intensified time-gated CMOS camera. RESULTS Because Cherenkov emission from tissue lies largely in the near-infrared spectrum, a controlled choice of ambient light that avoids this spectral band is ideal, along with a camera that is maximally sensitive to it. An RGB LED light source produced the best SNR out of all sources that mimic room light temperature. A 675-nm LP filter on the camera input further reduced ambient light detected (optical density > 3), achieving maximal SNR for Cherenkov emission near 40. Reduction of the room light signal reduced artifacts from specular reflection on the tissue surface and also minimized spurious Cherenkov signals from non-tissue features such as bolus. CONCLUSIONS LP filtering during image acquisition for near-infrared light in tandem with narrow band LED illuminated rooms improves image quality, trading off the loss of red wavelengths for better removal of room light in the image. This spectral filtering is also critically important to remove specular reflection in the images and allow for imaging of Cherenkov emission through clear bolus. Beyond time-gated external beam therapy systems, the spectral separation methods can be utilized for background removal for continuous treatment delivery methods including proton pencil beam scanning systems and brachytherapy.
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Affiliation(s)
- Mahbubur Rahman
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Petr Bruza
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Rachael Hachadorian
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Daniel Alexander
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Xu Cao
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Rongxiao Zhang
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Dartmouth College, Geisel School of Medicine, Department of Radiation Oncology, Hanover, New Hampshire, United States
- Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, New Hampshire, United States
| | - David J. Gladstone
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Dartmouth College, Geisel School of Medicine, Department of Radiation Oncology, Hanover, New Hampshire, United States
- Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, New Hampshire, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, New Hampshire, United States
- Dartmouth College, Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire, United States
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21
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Mannerberg A, Kügele M, Hamid S, Edvardsson A, Petersson K, Gunnlaugsson A, Bäck SÅ, Engelholm S, Ceberg S. Faster and more accurate patient positioning with surface guided radiotherapy for ultra-hypofractionated prostate cancer patients. Tech Innov Patient Support Radiat Oncol 2021; 19:41-45. [PMID: 34527818 PMCID: PMC8430426 DOI: 10.1016/j.tipsro.2021.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/24/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate if surface guided radiotherapy (SGRT) can decrease patient positioning time for localized prostate cancer patients compared to the conventional 3-point localization setup method. The patient setup accuracy was also compared between the two setup methods. MATERIALS AND METHODS A total of 40 localized prostate cancer patients were enrolled in this study, where 20 patients were positioned with surface imaging (SI) and 20 patients were positioned with 3-point localization. The setup time was obtained from the system log files of the linear accelerator and compared between the two methods. The patient setup was verified with daily orthogonal kV images which were matched based on the implanted gold fiducial markers. Resulting setup deviations between planned and online positions were compared between SI and 3-point localization. RESULTS Median setup time was 2:50 min and 3:28 min for SI and 3-point localization, respectively (p < 0.001). The median vector offset was 4.7 mm (range: 0-10.4 mm) for SI and 5.2 mm for 3-point localization (range: 0.41-17.3 mm) (p = 0.01). Median setup deviation in the individual translations for SI and 3-point localization respectively was: 1.1 mm and 1.9 mm in lateral direction (p = 0.02), 1.8 and 1.6 mm in the longitudinal direction (p = 0.41) and 2.2 mm and 2.6 mm in the vertical direction (p = 0.04). CONCLUSIONS Using SGRT for positioning of prostate cancer patients provided a faster and more accurate patient positioning compared to the conventional 3-point localization setup.
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Affiliation(s)
- Annika Mannerberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden,Corresponding author.
| | - Malin Kügele
- Department of Medical Radiation Physics, Lund University, Lund, Sweden,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sandra Hamid
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Anneli Edvardsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Kristoffer Petersson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden,Department of Oncology, Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - Adalsteinn Gunnlaugsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sven Å.J. Bäck
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Silke Engelholm
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sofie Ceberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
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22
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Naim A, Mansouri S, Saidi K, ELBaydaoui R, Mesradi MR. Innovative Non-Irradiating and Non-Invasive Per Fraction Control System in Radiotherapy: Surface-Guided Radiation Therapy Experience of Casablanca Cancer Center. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: Evaluation of the added value of radiotherapy guided by the cutaneous
surface in the positioning and monitoring of the radiotherapy
Patients and Methods: This study included 21 consecutive patients treated with an
accelerator dedicated to "True Beam®" stereotactic radiotherapy whose sessions were
monitored by an Optical Surface Monitoring System: "OSMS®". Excluded from our
study were treatments controlled exclusively by radiological imaging (IGRT).
Positioning variabilities were compared between conventional imaging and skin
surface infrared (OSMS) monitoring. Conventional imaging was in the form of
standard radiography (KV) performed during the treatment session or three-
dimensional by a series of Cone Beam computerized tomography (CBCT) scanned
images made at the beginning and end of The total time of the session and
the positioning variability’s in the 3 planes were
14
Results: The results of our study show that the cutaneous surface monitoring allowed
to obtain a faster alignment of the patient with an improvement in the overall time of
the session with a mean at 32% [14.5-49.27%], likewise a sub-millimeter positioning
quality for all locations with a median longitudinal distance of 0.02 cm [0-0.66], 01
cm verticality [0-0.32] and laterality 0.02 cm [0-0.77] This benefit is significantly
greater for cerebral and Head and neck’s localizations
21
Conclusion: Optical Surface Monitoring System (OSMS®) is a non-invasive and non-
irradiating means that allows reliable and fast
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23
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Corradini S, Niyazi M, Verellen D, Valentini V, Walsh S, Grosu AL, Lauber K, Giaccia A, Unger K, Debus J, Pieters BR, Guckenberger M, Senan S, Budach W, Rad R, Mayerle J, Belka C. X-change symposium: status and future of modern radiation oncology-from technology to biology. Radiat Oncol 2021; 16:27. [PMID: 33541387 PMCID: PMC7863262 DOI: 10.1186/s13014-021-01758-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Future radiation oncology encompasses a broad spectrum of topics ranging from modern clinical trial design to treatment and imaging technology and biology. In more detail, the application of hybrid MRI devices in modern image-guided radiotherapy; the emerging field of radiomics; the role of molecular imaging using positron emission tomography and its integration into clinical routine; radiation biology with its future perspectives, the role of molecular signatures in prognostic modelling; as well as special treatment modalities such as brachytherapy or proton beam therapy are areas of rapid development. More clinically, radiation oncology will certainly find an important role in the management of oligometastasis. The treatment spectrum will also be widened by the rational integration of modern systemic targeted or immune therapies into multimodal treatment strategies. All these developments will require a concise rethinking of clinical trial design. This article reviews the current status and the potential developments in the field of radiation oncology as discussed by a panel of European and international experts sharing their vision during the "X-Change" symposium, held in July 2019 in Munich (Germany).
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Affiliation(s)
- Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Dirk Verellen
- Department of Radiotherapy, Iridium Network, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincenzo Valentini
- Department of Radiation Oncology and Hematology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Università Cattolica S. Cuore, Rome, Italy
| | | | - Anca-L Grosu
- Department of Radiation Oncology, Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Kirsten Lauber
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Amato Giaccia
- Division of Radiation and Cancer Biology, Department of Radiation Oncology, Stanford University, Stanford, USA
| | - Kristian Unger
- Integrative Biology Group, Helmholtz Zentrum Munich, Munich, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Bradley R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Wilfried Budach
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Roland Rad
- Center for Translational Cancer Research (TranslaTUM), TU Munich, Munich, Germany
| | - Julia Mayerle
- Department of Internal Medicine II, University Hospital, LMU, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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24
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Kojima H, Takemura A, Kurokawa S, Ueda S, Noto K, Yokoyama H, Takamatsu S. Evaluation of technical performance of optical surface imaging system using conventional and novel stereotactic radiosurgery algorithms. J Appl Clin Med Phys 2020; 22:58-68. [PMID: 33369014 PMCID: PMC7882109 DOI: 10.1002/acm2.13152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/20/2020] [Accepted: 12/08/2020] [Indexed: 01/18/2023] Open
Abstract
The Catalyst HD (C-RAD Positioning AB, Uppsala, Sweden) optical surface imaging (OSI) system is able to manage interfractional patient positioning, intrafractional motion monitoring, and non-contact respiratory gating without x-ray exposure for radiation therapy. In recent years, a novel high-precision surface registration algorithm for stereotactic radiosurgery (SRS algorithm) has been released. This study aimed to evaluate the technical performance of the OSI system using rigid phantoms, by comparing the conventional and SRS algorithms. To determine the system's technical performance, isocenter displacements were calculated by surface image registration via the OSI system using head, thorax, and pelvis rigid phantoms. The reproducibility of positioning was evaluated by the mean value calculated by repeating the registration 10 times, without moving each phantom. The accuracy of positioning was evaluated by the mean value of the residual error, where the 10 offset values given to each phantom were subtracted from the isocenter displacement values. The stability of motion monitoring was evaluated by measuring isocenter drift during 20 min and averaging it over 10 measurements. For the head phantom, all tests were compared with the mask types and algorithms. As a result, for all sites and both algorithms, the reproducibility, accuracy, and stability for translation and rotation were <0.1 mm and <0.1°, <1.0 mm and <1.0°, and <0.1 mm and <0.1°, respectively. In particular, the SRS algorithm had a small absolute error and standard deviation of calculated isocenter displacement, and a significantly higher reproducibility and accuracy than the conventional algorithm (P < 0.01). There was no difference in the stability between the algorithms (P = 0.0280). The SRS algorithm was found to be suitable for the treatment of rigid body sites with less deformation and small area, such as the head and face.
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Affiliation(s)
- Hironori Kojima
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.,Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Akihiro Takemura
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Shogo Kurokawa
- Department of Radiation Technology, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Shinichi Ueda
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Kimiya Noto
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Haruna Yokoyama
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.,Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Shigeyuki Takamatsu
- Department of Radiation Therapy, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
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25
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Batista V, Meyer J, Kügele M, Al-Hallaq H. Clinical paradigms and challenges in surface guided radiation therapy: Where do we go from here? Radiother Oncol 2020; 153:34-42. [PMID: 32987044 DOI: 10.1016/j.radonc.2020.09.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/26/2022]
Abstract
Surface guided radiotherapy (SGRT) is becoming a routine tool for patient positioning for specific clinical sites in many clinics. However, it has not yet gained its full potential in terms of widespread adoption. This vision paper first examines some of the difficulties in transitioning to SGRT before exploring the current and future role of SGRT alongside and in concert with other imaging techniques. Finally, future horizons and innovative ideas that may shape and impact the direction of SGRT going forward are reviewed.
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Affiliation(s)
- Vania Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany.
| | - Juergen Meyer
- Seattle Cancer Care Alliance, University of Washington, Department of Radiation Oncology, United States.
| | - Malin Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden; Medical Radiation Physics, Department of Clinical Sciences, Lund University, Sweden.
| | - Hania Al-Hallaq
- The University of Chicago, Department of Radiation and Cellular Oncology, United States.
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26
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Nierer L, Walter F, Niyazi M, Shpani R, Landry G, Marschner S, von Bestenbostel R, Dinkel D, Essenbach G, Reiner M, Belka C, Corradini S. Radiotherapy in oncological emergencies: fast-track treatment planning. Radiat Oncol 2020; 15:215. [PMID: 32912293 PMCID: PMC7488151 DOI: 10.1186/s13014-020-01657-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE To report on our clinical experience with a newly implemented workflow for radiotherapy (RT) emergency treatments, which allows for a fast treatment application outside the regular working-hours, and its clinical applicability. METHODS Treatment planning of 18 emergency RT patients was carried out using diagnostic computed tomography (CT) without a dedicated RT simulation CT. The cone-beam CT (CBCT) deviations of the first RT treatment were analyzed regarding setup accuracy. Furthermore, feasibility of the "fast-track" workflow was evaluated with respect to dose deviations caused by different Hounsfield unit (HU) to relative electron density (rED) calibrations and RT treatment couch surface shapes via 3D gamma index analysis of exemplary treatment plans. The dosimetric uncertainty introduced by different CT calibrations was quantified. RESULTS Mean patient setup vs. CBCT isocenter deviations were (0.49 ± 0.44) cm (x), (2.68 ± 1.63) cm (y) and (1.80 ± 1.06) cm (z) for lateral, longitudinal and vertical directions, respectively. Three out of four dose comparisons between the emergency RT plan calculated on the diagnostic CT and the same plan calculated on the treatment planning CT showed clinically acceptable gamma passing rates, when correcting for surface artifacts. The maximum difference of rED was 0.054, while most parts of the CT calibration curves coincided well. CONCLUSION In an emergency RT setting, the use of diagnostic CT data for treatment planning might be time-saving and was shown to be suitable for many cases, considering reproducibility of patient setup, accuracy of initial patient setup and accuracy of dose-calculation.
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Affiliation(s)
- Lukas Nierer
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Franziska Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Roel Shpani
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Sebastian Marschner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Rieke von Bestenbostel
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Dominika Dinkel
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Gabriela Essenbach
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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27
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Freislederer P, Kügele M, Öllers M, Swinnen A, Sauer TO, Bert C, Giantsoudi D, Corradini S, Batista V. Recent advanced in Surface Guided Radiation Therapy. Radiat Oncol 2020; 15:187. [PMID: 32736570 PMCID: PMC7393906 DOI: 10.1186/s13014-020-01629-w] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 01/27/2023] Open
Abstract
The growing acceptance and recognition of Surface Guided Radiation Therapy (SGRT) as a promising imaging technique has supported its recent spread in a large number of radiation oncology facilities. Although this technology is not new, many aspects of it have only recently been exploited. This review focuses on the latest SGRT developments, both in the field of general clinical applications and special techniques.SGRT has a wide range of applications, including patient positioning with real-time feedback, patient monitoring throughout the treatment fraction, and motion management (as beam-gating in free-breathing or deep-inspiration breath-hold). Special radiotherapy modalities such as accelerated partial breast irradiation, particle radiotherapy, and pediatrics are the most recent SGRT developments.The fact that SGRT is nowadays used at various body sites has resulted in the need to adapt SGRT workflows to each body site. Current SGRT applications range from traditional breast irradiation, to thoracic, abdominal, or pelvic tumor sites, and include intracranial localizations.Following the latest SGRT applications and their specifications/requirements, a stricter quality assurance program needs to be ensured. Recent publications highlight the need to adapt quality assurance to the radiotherapy equipment type, SGRT technology, anatomic treatment sites, and clinical workflows, which results in a complex and extensive set of tests.Moreover, this review gives an outlook on the leading research trends. In particular, the potential to use deformable surfaces as motion surrogates, to use SGRT to detect anatomical variations along the treatment course, and to help in the establishment of personalized patient treatment (optimized margins and motion management strategies) are increasingly important research topics. SGRT is also emerging in the field of patient safety and integrates measures to reduce common radiotherapeutic risk events (e.g. facial and treatment accessories recognition).This review covers the latest clinical practices of SGRT and provides an outlook on potential applications of this imaging technique. It is intended to provide guidance for new users during the implementation, while triggering experienced users to further explore SGRT applications.
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Affiliation(s)
- P. Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - M. Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - M. Öllers
- Maastricht Radiation Oncology (MAASTRO), Maastricht, the Netherlands
| | - A. Swinnen
- Maastricht Radiation Oncology (MAASTRO), Maastricht, the Netherlands
| | - T.-O. Sauer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - C. Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - D. Giantsoudi
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - S. Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - V. Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
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28
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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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29
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Reitz D, Walter F, Schönecker S, Freislederer P, Pazos M, Niyazi M, Landry G, Alongi F, Bölke E, Matuschek C, Reiner M, Belka C, Corradini S. Stability and reproducibility of 6013 deep inspiration breath-holds in left-sided breast cancer. Radiat Oncol 2020; 15:121. [PMID: 32448224 PMCID: PMC7247126 DOI: 10.1186/s13014-020-01572-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/17/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Patients with left-sided breast cancer frequently receive deep inspiration breath-hold (DIBH) radiotherapy to reduce the risk of cardiac side effects. The aim of the present study was to analyze intra-breath-hold stability and inter-fraction breath-hold reproducibility in clinical practice. Material and methods Overall, we analyzed 103 patients receiving left-sided breast cancer radiotherapy using a surface-guided DIBH technique. During each treatment session the vertical motion of the patient was continuously measured by a surface guided radiation therapy (SGRT) system and automated gating control (beam on/off) was performed using an audio-visual patient feedback system. Dose delivery was automatically triggered when the tracking point was within a predefined gating window. Intra-breath-hold stability and inter-fraction reproducibility across all fractions of the entire treatment course were analyzed per patient. Results In the present series, 6013 breath-holds during beam-on time were analyzed. The mean amplitude of the gating window from the baseline breathing curve (maximum expiration during free breathing) was 15.8 mm (95%-confidence interval: [8.5–30.6] mm) and had a width of 3.5 mm (95%-CI: [2–4.3] mm). As a measure of intra-breath-hold stability, the median standard deviation of the breath-hold level during DIBH was 0.3 mm (95%-CI: [0.1–0.9] mm). Similarly, the median absolute intra-breath-hold linear amplitude deviation was 0.4 mm (95%-CI: [0.01–2.1] mm). Reproducibility testing showed good inter-fractional reliability, as the maximum difference in the breathing amplitudes in all patients and all fractions were 1.3 mm on average (95%-CI: [0.5–2.6] mm). Conclusion The clinical integration of an optical surface scanner enables a stable and reliable DIBH treatment delivery during SGRT for left-sided breast cancer in clinical routine.
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Affiliation(s)
- D Reitz
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - F Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - S Schönecker
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - P Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - M Pazos
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - M Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - G Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - F Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.,University of Brescia, Brescia, Italy
| | - E Bölke
- Department of Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - C Matuschek
- Department of Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - M Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - C Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - S Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
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30
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Schmitt D, Blanck O, Gauer T, Fix MK, Brunner TB, Fleckenstein J, Loutfi-Krauss B, Manser P, Werner R, Wilhelm ML, Baus WW, Moustakis C. Technological quality requirements for stereotactic radiotherapy : Expert review group consensus from the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. Strahlenther Onkol 2020; 196:421-443. [PMID: 32211939 PMCID: PMC7182540 DOI: 10.1007/s00066-020-01583-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 12/25/2022]
Abstract
This review details and discusses the technological quality requirements to ensure the desired quality for stereotactic radiotherapy using photon external beam radiotherapy as defined by the DEGRO Working Group Radiosurgery and Stereotactic Radiotherapy and the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The covered aspects of this review are 1) imaging for target volume definition, 2) patient positioning and target volume localization, 3) motion management, 4) collimation of the irradiation and beam directions, 5) dose calculation, 6) treatment unit accuracy, and 7) dedicated quality assurance measures. For each part, an expert review for current state-of-the-art techniques and their particular technological quality requirement to reach the necessary accuracy for stereotactic radiotherapy divided into intracranial stereotactic radiosurgery in one single fraction (SRS), intracranial fractionated stereotactic radiotherapy (FSRT), and extracranial stereotactic body radiotherapy (SBRT) is presented. All recommendations and suggestions for all mentioned aspects of stereotactic radiotherapy are formulated and related uncertainties and potential sources of error discussed. Additionally, further research and development needs in terms of insufficient data and unsolved problems for stereotactic radiotherapy are identified, which will serve as a basis for the future assignments of the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The review was group peer-reviewed, and consensus was obtained through multiple working group meetings.
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Affiliation(s)
- Daniela Schmitt
- Klinik für Radioonkologie und Strahlentherapie, National Center for Radiation Research in Oncology (NCRO), Heidelberger Institut für Radioonkologie (HIRO), Universitätsklinikum Heidelberg, Heidelberg, Germany.
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Tobias Gauer
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Michael K Fix
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Thomas B Brunner
- Universitätsklinik für Strahlentherapie, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Jens Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Britta Loutfi-Krauss
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Peter Manser
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Rene Werner
- Institut für Computational Neuroscience, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maria-Lisa Wilhelm
- Klinik für Strahlentherapie, Universitätsmedizin Rostock, Rostock, Germany
| | - Wolfgang W Baus
- Klinik für Radioonkologie, CyberKnife- und Strahlentherapie, Universitätsklinikum Köln, Cologne, Germany
| | - Christos Moustakis
- Klinik für Strahlentherapie-Radioonkologie, Universitätsklinikum Münster, Münster, Germany
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Heinzerling JH, Hampton CJ, Robinson M, Bright M, Moeller BJ, Ruiz J, Prabhu R, Burri SH, Foster RD. Use of surface-guided radiation therapy in combination with IGRT for setup and intrafraction motion monitoring during stereotactic body radiation therapy treatments of the lung and abdomen. J Appl Clin Med Phys 2020; 21:48-55. [PMID: 32196944 PMCID: PMC7286017 DOI: 10.1002/acm2.12852] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/08/2020] [Accepted: 02/16/2020] [Indexed: 12/24/2022] Open
Abstract
Background and purpose Multiple techniques can be used to assist with more accurate patient setup and monitoring during Stereotactic body radiation therapy (SBRT) treatment. This study analyzes the accuracy of 3D surface mapping with Surface‐guided radiation therapy (SGRT) in detecting interfraction setup error and intrafraction motion during SBRT treatments of the lung and abdomen. Materials and Methods Seventy‐one patients with 85 malignant thoracic or abdominal tumors treated with SBRT were analyzed. For initial patient setup, an alternating scheme of kV/kV imaging or SGRT was followed by cone beam computed tomography (CBCT) for more accurate tumor volumetric localization. The CBCT six degree shifts after initial setup with each method were recorded to assess interfraction setup error. Patients were then monitored continuously with SGRT during treatment. If an intrafractional shift in any direction >2 mm for longer than 2 sec was detected by SGRT, then CBCT was repeated and the recorded deltas were compared to those detected by SGRT. Results Interfractional shifts after SGRT setup and CBCT were small in all directions with mean values of <5 mm and < 0.5 degrees in all directions. Additionally, 25 patients had detected intrafraction motion by SGRT during a total of 34 fractions. This resulted in 25 (73.5%) additional shifts of at least 2 mm on subsequent CBCT. When comparing the average vector detected shift by SGRT to the resulting vector shift on subsequent CBCT, no significant difference was found between the two. Conclusions Surface‐guided radiation therapy provides initial setup within 5 mm for patients treated with SBRT and can be used in place of skin marks or planar kV imaging prior to CBCT. In addition, continuous monitoring with SGRT during treatment was valuable in detecting potentially clinically meaningful intrafraction motion and was comparable in magnitude to shifts from additional CBCT scans. PTV margin reduction may be feasible for SBRT in the lung and abdomen when using SGRT for continuous patient monitoring during treatment.
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Affiliation(s)
- John H Heinzerling
- Levine Cancer Institute, Southeast Radiation Oncology Group, Atrium Health, Charlotte, NC, USA
| | - Carnell J Hampton
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health, Charlotte, NC, USA
| | - Myra Robinson
- Levine Cancer Institute, Department of Biostatistics, Atrium Health, Charlotte, NC, USA
| | - Megan Bright
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health, Charlotte, NC, USA
| | - Benjamin J Moeller
- Levine Cancer Institute, Southeast Radiation Oncology Group, Atrium Health, Charlotte, NC, USA
| | - Justin Ruiz
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health, Charlotte, NC, USA
| | - Roshan Prabhu
- Levine Cancer Institute, Southeast Radiation Oncology Group, Atrium Health, Charlotte, NC, USA
| | - Stuart H Burri
- Levine Cancer Institute, Southeast Radiation Oncology Group, Atrium Health, Charlotte, NC, USA
| | - Ryan D Foster
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health, Charlotte, NC, USA
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Koban KC, Etzel L, Li Z, Pazos M, Schönecker S, Belka C, Giunta RE, Schenck TL, Corradini S. Three-dimensional surface imaging in breast cancer: a new tool for clinical studies? Radiat Oncol 2020; 15:52. [PMID: 32111228 PMCID: PMC7049187 DOI: 10.1186/s13014-020-01499-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/18/2020] [Indexed: 12/11/2022] Open
Abstract
Background Three-dimensional Surface Imaging (3DSI) is a well-established method to objectively monitor morphological changes in the female breast in the field of plastic surgery. In contrast, in radiation oncology we are still missing effective tools, which can objectively and reproducibly assess and document adverse events in breast cancer radiotherapy within the framework of clinical studies. The aim of the present study was to apply structured-light technology as a non-invasive and objective approach for the documentation of cosmetic outcome and early effects of breast radiotherapy as a proof of principle. Methods Weekly 3DSI images of patients receiving either conventionally fractionated radiation treatment (CF-RT) or hypofractionated radiation treatment (HF-RT) were acquired during the radiotherapy treatment and clinical follow-up. The portable Artec Eva scanner (Artec 3D Inc., Luxembourg) recorded 3D surface images for the analysis of breast volumes and changes in skin appearance. Statistical analysis compared the impact of the two different fractionation regimens and the differences between the treated and the contralateral healthy breast. Results Overall, 38 patients and a total of 214 breast imaging sessions were analysed. Patients receiving CF-RT showed a significantly higher frequency of breast erythema compared to HF-RT (93.3% versus 34.8%, p = 0.003) during all observed imaging sessions. Moreover, we found a statistically significant (p < 0.05) volumetric increase of the treated breast of the entire cohort between baseline (379 ± 196 mL) and follow-up imaging at 3 months (437 ± 224 mL), as well as from week 3 of radiotherapy (391 ± 198 mL) to follow-up imaging. In both subgroups of patients undergoing either CF-RT or HF-RT, there was a statistically significant increase (p < 0.05) in breast volumes between baseline and 3 months follow-up. There were no statistically significant skin or volumetric changes of the untreated healthy breasts. Conclusions This is the first study utilizing 3D structured-light technology as a non-invasive and objective approach for the documentation of patients receiving breast radiotherapy. 3DSI offers potential as a non-invasive tool to objectively and precisely monitor the female breast in a radiooncological setting, allowing clinicians to objectively distinguish outcomes of different therapy modalities.
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Affiliation(s)
- Konstantin Christoph Koban
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Pettenkoferstraße 8a, 80336, Munich, Germany.
| | - Lucas Etzel
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Pettenkoferstraße 8a, 80336, Munich, Germany
| | - Zhouxiao Li
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Pettenkoferstraße 8a, 80336, Munich, Germany
| | - Montserrat Pazos
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stephan Schönecker
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Riccardo Enzo Giunta
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Pettenkoferstraße 8a, 80336, Munich, Germany
| | - Thilo Ludwig Schenck
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Pettenkoferstraße 8a, 80336, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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Pazos M, Walter F, Reitz D, Schönecker S, Konnerth D, Schäfer A, Rottler M, Alongi F, Freislederer P, Niyazi M, Belka C, Corradini S. Impact of surface-guided positioning on the use of portal imaging and initial set-up duration in breast cancer patients. Strahlenther Onkol 2019; 195:964-971. [PMID: 31332457 DOI: 10.1007/s00066-019-01494-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/27/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The impact of optical surface guidance on the use of portal imaging and the initial set-up duration in patients receiving postoperative radiotherapy of the breast or chest wall was investigated. MATERIAL AND METHODS A retrospective analysis was performed including breast cancer patients who received postoperative radiotherapy between January 2016 and December 2016. One group of patients received treatment before the optical surface scanner was installed (no-OSS) and the other group was positioned using the additional information derived by the optical surface scanner (OSS). The duration of the initial set-up was recorded for each patient and a comparison of both groups was performed. Accordingly, the differences between planned and actually acquired portal images during the course of radiotherapy were compared between both groups. RESULTS A total of 180 breast cancer patients were included (90 no-OSS, 90 OSS) in this analysis. Of these, 30 patients with left-sided breast cancer received radiotherapy in deep inspiration breath hold (DIBH). The mean set-up time was 10 min and 18 s and no significant difference between the two groups of patients was found (p = 0.931). The mean set-up time in patients treated without DIBH was 9 min and 45 s compared to 13 min with DIBH (p < 0.001), as portal imaging was performed in DIBH. No significant difference was found in the number of acquired to the planned number of portal images during the entire radiotherapy treatment for both groups (p = 0.287). CONCLUSION Optical surface imaging is a valuable addition for primary patient set-up. The findings confirm that the addition of surface-based imaging did not prolong the clinical workflow and had no significant impact on the number of portal verification images carried out during the course of radiotherapy.
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Affiliation(s)
- Montserrat Pazos
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Franziska Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
| | - Daniel Reitz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stephan Schönecker
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Dinah Konnerth
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Annemarie Schäfer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maya Rottler
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar-Verona, Italy.,University of Brescia, Brescia, Italy
| | - Philipp Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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