1
|
Zhang J, Wang L, Xie C, Yang Z, Xu B, Li X. Novel utilization and quantification of Xsight diaphragm tracking for respiratory motion compensation in Cyberknife Synchrony treatment of liver tumors. J Appl Clin Med Phys 2024; 25:e14341. [PMID: 38622894 PMCID: PMC11244677 DOI: 10.1002/acm2.14341] [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: 10/18/2023] [Revised: 12/06/2023] [Accepted: 03/09/2024] [Indexed: 04/17/2024] Open
Abstract
PURPOSE The Xsight lung tracking system (XLTS) utilizes an advanced image processing algorithm to precisely identify the position of a tumor and determine its location in orthogonal x-ray images, instead of finding fiducials, thereby minimizing the risk of fiducial insertion-related side effects. To assess and gauge the effectiveness of CyberKnife Synchrony in treating liver tumors located in close proximity to or within the diaphragm, we employed the Xsight diaphragm tracking system (XDTS), which was based on the XLTS. METHODS We looked back at the treatment logs of 11 patients (8/11 [XDTS], 3/11 [Fiducial-based Target Tracking System-FTTS]) who had liver tumors in close proximity to or within the diaphragm. And the results are compared with the patients who undergo the treatment of FTTS. The breathing data information was calculated as a rolling average to reduce the effect of irregular breathing. We tested the tracking accuracy with a dynamic phantom (18023-A) on the basis of patient-specific respiratory curve. RESULTS The average values for the XDTS and FTTS correlation errors were 1.38 ± 0.65 versus 1.50 ± 0.26 mm (superior-inferior), 1.28 ± 0.48 versus 0.40 ± 0.09 mm (left-right), and 0.96 ± 0.32 versus 0.47 ± 0.10 mm(anterior-posterior), respectively. The prediction errors for two methods of 0.65 ± 0.16 versus 5.48 ± 3.33 mm in the S-I direction, 0.34 ± 0.10 versus 1.41 ± 0.76 mm in the A-P direction, and 0.22 ± 0.072 versus 1.22 ± 0.48 mm in the L-R direction. The coverage rate of FTTS slightly less than that of XDTS, such as 96.53 ± 8.19% (FTTS) versus 98.03 ± 1.54 (XDTS). The prediction error, the motion amplitude, and the variation of the respiratory center phase were strongly related to each other. Especially, the higher the amplitude and the variation, the higher the prediction error. CONCLUSION The diaphragm has the potential to serve as an alternative to gold fiducial markers for detecting liver tumors in close proximity or within it. We also found that we needed to reduce the motion amplitude and train the respiration of the patients during liver radiotherapy, as well as control and evaluate their breathing.
Collapse
Affiliation(s)
- Jianping Zhang
- Department of Radiation OncologyFujian Medical University Union HospitalFuzhouChina
- Fujian Medical University Union Clinical Medicine CollegeFujian Medical UniversityFuzhouChina
- Department of Medical Imaging TechnologyCollege of Medical ImagingFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University)FuzhouChina
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies)FuzhouChina
| | - Lin Wang
- Department of Radiation OncologyFujian Medical University Union HospitalFuzhouChina
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University)FuzhouChina
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies)FuzhouChina
| | - Chenyu Xie
- Department of Medical Imaging TechnologyCollege of Medical ImagingFujian Medical UniversityFuzhouChina
| | - Zhiyu Yang
- Department of Radiation OncologyFujian Medical University Union HospitalFuzhouChina
| | - Benhua Xu
- Department of Radiation OncologyFujian Medical University Union HospitalFuzhouChina
- Fujian Medical University Union Clinical Medicine CollegeFujian Medical UniversityFuzhouChina
- Department of Medical Imaging TechnologyCollege of Medical ImagingFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University)FuzhouChina
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies)FuzhouChina
| | - Xiaobo Li
- Department of Radiation OncologyFujian Medical University Union HospitalFuzhouChina
- Fujian Medical University Union Clinical Medicine CollegeFujian Medical UniversityFuzhouChina
- Department of Medical Imaging TechnologyCollege of Medical ImagingFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University)FuzhouChina
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies)FuzhouChina
- Department of Engineering PhysicsTsinghua UniversityBeijingChina
| |
Collapse
|
2
|
Liulu X, Balaji P, Barber J, De Silva K, Murray T, Hickey A, Campbell T, Harris J, Gee H, Ahern V, Kumar S, Hau E, Qian PC. Radiation therapy for ventricular arrhythmias. J Med Imaging Radiat Oncol 2024. [PMID: 38698577 DOI: 10.1111/1754-9485.13662] [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: 01/02/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
Ventricular arrhythmias (VA) can be life-threatening arrhythmias that result in significant morbidity and mortality. Catheter ablation (CA) is an invasive treatment modality that can be effective in the treatment of VA where medications fail. Recurrence occurs commonly following CA due to an inability to deliver lesions of adequate depth to cauterise the electrical circuits that drive VA or reach areas of scar responsible for VA. Stereotactic body radiotherapy is a non-invasive treatment modality that allows volumetric delivery of energy to treat circuits that cannot be reached by CA. It overcomes the weaknesses of CA and has been successfully utilised in small clinical trials to treat refractory VA. This article summarises the current evidence for this novel treatment modality and the steps that will be required to bring it to the forefront of VA treatment.
Collapse
Affiliation(s)
- Xingzhou Liulu
- Cardiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Poornima Balaji
- Cardiology Department, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jeffrey Barber
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kasun De Silva
- Cardiology Department, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tiarne Murray
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Andrew Hickey
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Timothy Campbell
- Cardiology Department, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jill Harris
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Harriet Gee
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Verity Ahern
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Cardiology Department, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Eric Hau
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Translational Radiation Biology and Oncology Laboratory, Centre for Cancer Research, The Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- Blacktown Hematology and Cancer Centre, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Pierre C Qian
- Cardiology Department, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Sengupta C, Nguyen DT, Moodie T, Mason D, Luo J, Causer T, Liu SF, Brown E, Inskip L, Hazem M, Chao M, Wang T, Lee YY, van Gysen K, Sullivan E, Cosgriff E, Ramachandran P, Poulsen P, Booth J, O'Brien R, Greer P, Keall P. The first clinical implementation of real-time 6 degree-of-freedom image-guided radiotherapy for liver SABR patients. Radiother Oncol 2024; 190:110031. [PMID: 38008417 DOI: 10.1016/j.radonc.2023.110031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Multiple survey results have identified a demand for improved motion management for liver cancer IGRT. Until now, real-time IGRT for liver has been the domain of dedicated and expensive cancer radiotherapy systems. The purpose of this study was to clinically implement and characterise the performance of a novel real-time 6 degree-of-freedom (DoF) IGRT system, Kilovoltage Intrafraction Monitoring (KIM) for liver SABR patients. METHODS/MATERIALS The KIM technology segmented gold fiducial markers in intra-fraction x-ray images as a surrogate for the liver tumour and converted the 2D segmented marker positions into a real-time 6DoF tumour position. Fifteen liver SABR patients were recruited and treated with KIM combined with external surrogate guidance at three radiotherapy centres in the TROG 17.03 LARK multi-institutional prospective clinical trial. Patients were either treated in breath-hold or in free breathing using the gating method. The KIM localisation accuracy and dosimetric accuracy achieved with KIM + external surrogate were measured and the results were compared to those with the estimated external surrogate alone. RESULTS The KIM localisation accuracy was 0.2±0.9 mm (left-right), 0.3±0.6 mm (superior-inferior) and 1.2±0.8 mm (anterior-posterior) for translations and -0.1◦±0.8◦ (left-right), 0.6◦±1.2◦ (superior-inferior) and 0.1◦±0.9◦ (anterior-posterior) for rotations. The cumulative dose to the GTV with KIM + external surrogate was always within 5% of the plan. In 2 out of 15 patients, >5% dose error would have occurred to the GTV and an organ-at-risk with external surrogate alone. CONCLUSIONS This work demonstrates that real-time 6DoF IGRT for liver can be implemented on standard radiotherapy systems to improve treatment accuracy and safety. The observations made during the treatments highlight the potential false assurance of using traditional external surrogates to assess tumour motion in patients and the need for ongoing improvement of IGRT technologies.
Collapse
Affiliation(s)
| | | | | | - Daniel Mason
- Nepean Cancer & Wellness Centre, Nepean Hospital, Australia
| | - Jianjie Luo
- Nepean Cancer & Wellness Centre, Nepean Hospital, Australia
| | - Trent Causer
- Nepean Cancer & Wellness Centre, Nepean Hospital, Australia
| | - Sau Fan Liu
- Department of Radiation Oncology, Princess Alexandra Hospital, Australia
| | - Elizabeth Brown
- Department of Radiation Oncology, Princess Alexandra Hospital, Australia
| | | | - Maryam Hazem
- Nepean Cancer & Wellness Centre, Nepean Hospital, Australia
| | - Menglei Chao
- Nepean Cancer & Wellness Centre, Nepean Hospital, Australia
| | - Tim Wang
- Crown Princess Mary Cancer Centre, Australia
| | - Yoo Y Lee
- Department of Radiation Oncology, Princess Alexandra Hospital, Australia
| | | | | | | | | | - Per Poulsen
- Department of Oncology, Aarhus University Hospital, Denmark; Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Jeremy Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; Institute of Medical Physics, The University of Sydney, Australia
| | - Ricky O'Brien
- Image X Institute, The University of Sydney, Australia; RMIT University, Australia
| | - Peter Greer
- Department of Radiation Oncology, Calvary Mater Newcastle, Australia
| | - Paul Keall
- Image X Institute, The University of Sydney, Australia
| |
Collapse
|
4
|
Rivero-Moreno Y, Rodriguez M, Losada-Muñoz P, Redden S, Lopez-Lezama S, Vidal-Gallardo A, Machado-Paled D, Cordova Guilarte J, Teran-Quintero S. Autonomous Robotic Surgery: Has the Future Arrived? Cureus 2024; 16:e52243. [PMID: 38352080 PMCID: PMC10862530 DOI: 10.7759/cureus.52243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 02/16/2024] Open
Abstract
Autonomous robotic surgery represents a pioneering field dedicated to the integration of robotic systems with varying degrees of autonomy for the execution of surgical procedures. This paradigm shift is made possible by the progressive integration of artificial intelligence (AI) and machine learning (ML) into the realm of surgical interventions. While the majority of autonomous robotic systems remain in the experimental phase, a notable subset has successfully transitioned into clinical applications. Noteworthy procedures, such as venipuncture, hair implantations, intestinal anastomosis, total knee replacement, cochlear implant, radiosurgery, and knot tying, among others, exemplify the current capabilities of autonomous surgical systems. This review endeavors to comprehensively address facets of autonomous robotic surgery, commencing with a concise elucidation of fundamental concepts and traversing the pivotal milestones in the historical evolution of robotic surgery. This historical trajectory underscores the incremental assimilation of autonomous systems into surgical practices. This review aims to address topics related to autonomous robotic surgery, starting with a description of fundamental concepts and going through the milestones in robotic surgery history that also show the gradual incorporations of autonomous systems. It also includes a discussion of the key benefits and risks of this technology, the degrees of autonomy in surgical robots, their limitations, the current legal regulations governing their usage, and the main ethical concerns inherent to their nature.
Collapse
Affiliation(s)
| | | | | | - Samantha Redden
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, USA
| | | | | | | | | | | |
Collapse
|
5
|
Mochizuki Z, Saito M, Suzuki T, Mochizuki K, Hasegawa J, Nemoto H, Satani K, Takahashi H, Onishi H. Cycle-generative adversarial network-based bone suppression imaging for highly accurate markerless motion tracking of lung tumors for cyberknife irradiation therapy. J Appl Clin Med Phys 2024; 25:e14212. [PMID: 37985163 PMCID: PMC10795441 DOI: 10.1002/acm2.14212] [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: 01/04/2023] [Revised: 10/01/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023] Open
Abstract
PURPOSE Lung tumor tracking during stereotactic radiotherapy with the CyberKnife can misrecognize tumor location under conditions where similar patterns exist in the search area. This study aimed to develop a technique for bone signal suppression during kV-x-ray imaging. METHODS Paired CT images were created with or without bony structures using a 4D extended cardiac-torso phantom (XCAT phantom) in 56 cases. Subsequently, 3020 2D x-ray images were generated. Images with bone were input into cycle-consistent adversarial network (CycleGAN) and the bone suppressed images on the XCAT phantom (BSIphantom ) were created. They were then compared to images without bone using the structural similarity index measure (SSIM) and peak signal-to-noise ratio (PSNR). Next, 1000 non-simulated treatment images from real cases were input into the training model, and bone-suppressed images of the patient (BSIpatient ) were created. Zero means normalized cross correlation (ZNCC) by template matching between each of the actual treatment images and BSIpatient were calculated. RESULTS BSIphantom values were compared to their paired images without bone of the XCAT phantom test data; SSIM and PSNR were 0.90 ± 0.06 and 24.54 ± 4.48, respectively. It was visually confirmed that only bone was selectively suppressed without significantly affecting tumor visualization. The ZNCC values of the actual treatment images and BSIpatient were 0.763 ± 0.136 and 0.773 ± 0.143, respectively. The BSIpatient showed improved recognition accuracy over the actual treatment images. CONCLUSIONS The proposed bone suppression imaging technique based on CycleGAN improves image recognition, making it possible to achieve highly accurate motion tracking irradiation.
Collapse
Affiliation(s)
- Zennosuke Mochizuki
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Masahide Saito
- Department of RadiologyUniversity of YamanashiChuo‐cityYamanashiJapan
| | - Toshihiro Suzuki
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
- Department of RadiologyUniversity of YamanashiChuo‐cityYamanashiJapan
| | - Koji Mochizuki
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Junichi Hasegawa
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Hikaru Nemoto
- Department of RadiologyUniversity of YamanashiChuo‐cityYamanashiJapan
| | - Kenichiro Satani
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Hiroshi Takahashi
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Hiroshi Onishi
- Department of RadiologyUniversity of YamanashiChuo‐cityYamanashiJapan
| |
Collapse
|
6
|
Nemoto H, Saito M, Suzuki T, Suzuki H, Sano N, Mochizuki Z, Mochizuki K, Ueda K, Komiyama T, Marino K, Aoki S, Oguri M, Takahashi H, Onishi H. Evaluation of computed tomography metal artifact and CyberKnife fiducial recognition for novel size fiducial markers. J Appl Clin Med Phys 2023; 24:e14142. [PMID: 37672211 PMCID: PMC10691645 DOI: 10.1002/acm2.14142] [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: 12/06/2022] [Revised: 06/28/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE This study aimed to compare fiducial markers used in CyberKnife treatment in terms of metal artifact intensity observed in CT images and fiducial recognition in the CyberKnife system affected by patient body thickness and type of marker. METHODS Five markers, ACCULOC 0.9 mm × 3 mm, Ball type Gold Anchor (GA) 0.28 mm × 10 mm, 0.28 mm × 20 mm, and novel size GA 0.4 mm × 10 mm, 0.4 mm × 20 mm were evaluated. To evaluate metal artifacts of CT images, two types of CT images of water-equivalent gels with each marker were acquired using Aquilion LB CT scanner, one applied SEMAR (SEMAR-on) and the other did not apply this technique (SEMAR-off). The evaluation metric of artifact intensity (MSD ) which represents a variation of CT values were compared for each marker. Next, 5, 15, and 20 cm thickness of Tough Water (TW) was placed on the gel under the condition of overlapping the vertebral phantom in the Target Locating System, and the live image of each marker was acquired to compare fiducial recognition. RESULTS The mean MSD of SEMAR-off was 78.80, 74.50, 97.25, 83.29, and 149.64 HU for ACCULOC, GA0.28 mm × 10 mm, 20 mm, and 0.40 mm × 10 mm, 20 mm, respectively. In the same manner, that of SEMAR-on was 23.52, 20.26, 26.76, 24.89, and 33.96 HU, respectively. Fiducial recognition decreased in the order of 5, 15, and 20 cm thickness, and GA 0.4 × 20 mm showed the best recognition at thickness of 20 cm TW. CONCLUSIONS We demonstrated the potential to reduce metal artifacts in the CT image to the same level for all the markers we evaluated by applying SEMAR. Additionally, the fiducial recognition of each marker may vary depending on the thickness of the patient's body. Particularly, we showed that GA 0.40 × 20 mm may have more optimal recognition for CyberKnife treatment in cases of high bodily thickness in comparison to the other markers.
Collapse
Affiliation(s)
- Hikaru Nemoto
- Department of Advanced Biomedical ImagingUniversity of YamanashiYamanashiJapan
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Masahide Saito
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Hidekazu Suzuki
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Naoki Sano
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Koji Mochizuki
- Kasugai CyberKnife Rehabilitation HospitalYamanashiJapan
| | - Koji Ueda
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Kan Marino
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Shinichi Aoki
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Mitsuhiko Oguri
- Department of RadiologyShizuoka General HospitalShizuokaJapan
| | | | - Hiroshi Onishi
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| |
Collapse
|
7
|
García‐Fuentes JD, Sevillano D, Colmenares R, Capuz AB, Morís R, Cámara M, Galiano P, Williamson S, Béjar MJ, Prieto D, García‐Vicente F. Evaluation of a high resolution diode array for CyberKnife quality assurance. J Appl Clin Med Phys 2023; 24:e14053. [PMID: 37247259 PMCID: PMC10476977 DOI: 10.1002/acm2.14053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/22/2023] [Accepted: 05/01/2023] [Indexed: 05/31/2023] Open
Abstract
PURPOSE The CyberKnife quality assurance (QA) program relies mainly on the use of radiochromic film (RCF). We aimed at evaluating high-resolution arrays of detectors as an alternative to films for CyberKnife machine QA. METHODS This study will test the SRS Mapcheck (Sun Nuclear, Melbourne, Florida, USA) diode array and its own software, which allows three tests of the CyberKnife QA program to be performed. The first one is a geometrical accuracy test based on the delivery of two orthogonal beams (Automated Quality Assurance, AQA). Besides comparing the constancy and repeatability of both methods, known errors will be introduced to check their sensitivity. The second checks the constancy of the iris collimator field sizes (Iris QA). Changes in the field sizes will be introduced to study the array sensitivity. The last test checks the correct positioning of the multileaf collimator (MLC). It will be tested introducing known systematic displacements to whole banks and to single leaves. RESULTS The results of the RCF and diode array were equivalent (maximum differences of 0.18 ± 0.14 mm) for the AQA test, showing the array a higher reproducibility. When known errors were introduced, both methods behaved linearly with similar slopes. Regarding Iris QA, the array measurements are highly linear when changes in the field sizes are introduced. Linear regressions show slopes of 0.96-1.17 with r2 above 0.99 in all field sizes. Diode array seems to detect changes of 0.1 mm. In MLC QA, systematic errors of the whole bank of leaves were not detected by the array, while single leaf errors were detected. CONCLUSIONS The diode array is sensitive and accurate in the AQA and Iris QA tests, which give us the possibility of substituting RCF with a diode array. QA would be performed faster than using the film procedure, obtaining reliable results. Regarding the MLC QA, the inability to detect systematic displacements make it difficult to confidently use the detector.
Collapse
Affiliation(s)
| | - David Sevillano
- Department of Medical PhysicsHospital Universitario Ramón y Cajal, IRyCISMadridSpain
- Department of RadiologyRehabilitation and PhysiotherapyUniversidad Complutense de MadridMadridSpain
| | - Rafael Colmenares
- Department of Medical PhysicsHospital Universitario Ramón y Cajal, IRyCISMadridSpain
| | - Ana B. Capuz
- Department of Medical PhysicsHospital Universitario Ramón y Cajal, IRyCISMadridSpain
| | - Rafael Morís
- Department of Medical PhysicsHospital Universitario Ramón y Cajal, IRyCISMadridSpain
| | - Miguel Cámara
- Department of Medical PhysicsHospital Universitario Ramón y Cajal, IRyCISMadridSpain
| | - Pablo Galiano
- Department of Medical PhysicsHospital Universitario Ramón y Cajal, IRyCISMadridSpain
| | - Sandra Williamson
- Department of Medical PhysicsHospital Universitario Ramón y Cajal, IRyCISMadridSpain
| | - María J. Béjar
- Department of Medical PhysicsHospital Universitario Ramón y Cajal, IRyCISMadridSpain
| | - Daniel Prieto
- Department of Medical PhysicsHospital Universitario Ramón y Cajal, IRyCISMadridSpain
| | | |
Collapse
|
8
|
Le Reun E, Granzotto A, Pêtre A, Bodgi L, Beldjoudi G, Lacornerie T, Vallet V, Bouchet A, Al-Choboq J, Bourguignon M, Thariat J, Bourhis J, Lartigau E, Foray N. Influence of the Hypersensitivity to Low Dose Phenomenon on the Tumor Response to Hypofractionated Stereotactic Body Radiation Therapy. Cancers (Basel) 2023; 15:3979. [PMID: 37568795 PMCID: PMC10416967 DOI: 10.3390/cancers15153979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Stereotactic body radiation therapy (SBRT) has made the hypofractionation of high doses delivered in a few sessions more acceptable. While the benefits of hypofractionated SBRT have been attributed to additional vascular, immune effects, or specific cell deaths, a radiobiological and mechanistic model is still needed. By considering each session of SBRT, the dose is divided into hundreds of minibeams delivering some fractions of Gy. In such a dose range, the hypersensitivity to low dose (HRS) phenomenon can occur. HRS produces a biological effect equivalent to that produced by a dose 5-to-10 times higher. To examine whether HRS could contribute to enhancing radiation effects under SBRT conditions, we exposed tumor cells of different HRS statuses to SBRT. Four human HRS-positive and two HRS-negative tumor cell lines were exposed to different dose delivery modes: a single dose of 0.2 Gy, 2 Gy, 10 × 0.2 Gy, and a single dose of 2 Gy using a non-coplanar isocentric minibeams irradiation mode were delivered. Anti-γH2AX immunofluorescence, assessing DNA double-strand breaks (DSB), was applied. In the HRS-positive cells, the DSB produced by 10 × 0.2 Gy and 2 Gy, delivered by tens of minibeams, appeared to be more severe, and they provided more highly damaged cells than in the HRS-negative cells, suggesting that more severe DSB are induced in the "SBRT modes" conditions when HRS occurs in tumor. Each SBRT session can be viewed as hyperfractionated dose delivery by means of hundreds of low dose minibeams. Under current SBRT conditions (i.e., low dose per minibeam and not using ultra-high dose-rate), the response of HRS-positive tumors to SBRT may be enhanced significantly. Interestingly, similar conclusions were reached with HRS-positive and HRS-negative untransformed fibroblast cell lines, suggesting that the HRS phenomenon may also impact the risk of post-RT tissue overreactions.
Collapse
Affiliation(s)
- Eymeric Le Reun
- U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon-Bérard, Inserm, 28 Rue Laennec, 69008 Lyon, France; (E.L.R.); (A.G.); (A.P.); (A.B.); (J.A.-C.); (M.B.)
- Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), 46 Rue du Bugnon, 1011 Lausanne, Switzerland; (V.V.); (J.B.)
| | - Adeline Granzotto
- U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon-Bérard, Inserm, 28 Rue Laennec, 69008 Lyon, France; (E.L.R.); (A.G.); (A.P.); (A.B.); (J.A.-C.); (M.B.)
| | - Adeline Pêtre
- U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon-Bérard, Inserm, 28 Rue Laennec, 69008 Lyon, France; (E.L.R.); (A.G.); (A.P.); (A.B.); (J.A.-C.); (M.B.)
- Département de Radiothérapie, Centre Léon-Bérard, 28 Rue Laennec, 69008 Lyon, France;
| | - Larry Bodgi
- Department of Radiation Oncology, American University of Beirut Medical Center, Riad El-Solh, Beirut 1107-2020, Lebanon;
| | - Guillaume Beldjoudi
- Département de Radiothérapie, Centre Léon-Bérard, 28 Rue Laennec, 69008 Lyon, France;
| | - Thomas Lacornerie
- Département de Radiothérapie, Centre Oscar-Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France; (T.L.); (E.L.)
| | - Véronique Vallet
- Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), 46 Rue du Bugnon, 1011 Lausanne, Switzerland; (V.V.); (J.B.)
| | - Audrey Bouchet
- U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon-Bérard, Inserm, 28 Rue Laennec, 69008 Lyon, France; (E.L.R.); (A.G.); (A.P.); (A.B.); (J.A.-C.); (M.B.)
| | - Joëlle Al-Choboq
- U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon-Bérard, Inserm, 28 Rue Laennec, 69008 Lyon, France; (E.L.R.); (A.G.); (A.P.); (A.B.); (J.A.-C.); (M.B.)
| | - Michel Bourguignon
- U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon-Bérard, Inserm, 28 Rue Laennec, 69008 Lyon, France; (E.L.R.); (A.G.); (A.P.); (A.B.); (J.A.-C.); (M.B.)
- Département de Biophysique et Médecine Nucléaire, Université Paris Saclay, Versailles St. Quentin en Yvelines, 78035 Versailles, France
| | - Juliette Thariat
- Département de Radiothérapie, Centre François-Baclesse, 3 Avenue du Général Harris, 14076 Caen, France;
| | - Jean Bourhis
- Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), 46 Rue du Bugnon, 1011 Lausanne, Switzerland; (V.V.); (J.B.)
| | - Eric Lartigau
- Département de Radiothérapie, Centre Oscar-Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France; (T.L.); (E.L.)
| | - Nicolas Foray
- U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon-Bérard, Inserm, 28 Rue Laennec, 69008 Lyon, France; (E.L.R.); (A.G.); (A.P.); (A.B.); (J.A.-C.); (M.B.)
| |
Collapse
|
9
|
Masi L, Doro R, Di Cataldo V, Francolini G, Zani M, Visani L, Meattini I, Livi L. Preoperative single fraction breast radiotherapy: Intra-fraction geometric uncertainties and dosimetric implications. Phys Med 2023; 112:102638. [PMID: 37441821 DOI: 10.1016/j.ejmp.2023.102638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/12/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE A preoperative breast robotic radiosurgery trial was concluded in our centre. Purposes of the present study were to evaluate retrospectively over the enrolled patients: i) respiratory patterns ii) tracking uncertainties iii) necessity of respiratory compensation iv) tracking errors dosimetric effects. METHODS 22 patients were treated in 21 Gy single fraction using CyberKnife (CK) respiratory modelling and tracking (SynchronyResp) and data extracted from log-files. Respiratory motion and baseline drifts (BD) were analyzed. SynchronyResp uncertainties were computed and compared with errors simulated for CK fiducial tracking without respiratory compensation. Plans were perturbed by tracking errors and perturbed doses calculated on the planning CT scan in order to simulate the dosimetric consequences of intra-fraction errors. RESULTS After BD correction, respiratory amplitudes were below 5.5 mm except one value of 8 mm. 50% of patients showed BD above 3 mm. Standard deviations of SynchronyResp errors remained within 2.1 mm. Standard deviations of tracking errors without respiratory compensation were comparable and below 2.5 mm. Using a 3 mm PTV margin, perturbed CTV coverage was below 95% (93.7%) just for one patient. The latter case presented a large CTV-Skin interface. Perturbed OAR doses were always judged clinically acceptable. CONCLUSION Intra-fraction geometric uncertainties and their effects were quantified for breast neoadjuvant CK treatments. Data indicated that in the majority of cases respiratory compensation may be disabled without increasing uncertainties and reducing treatment time, provided that fiducial intra-fraction tracking is performed to account for BD. Dosimetric effects are mostly not clinically relevant.
Collapse
Affiliation(s)
- Laura Masi
- Department of Medical Physics and Radiation Oncology, IFCA, Florence, Italy.
| | - Raffaela Doro
- Department of Medical Physics and Radiation Oncology, IFCA, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Margherita Zani
- Medical Physics Unit, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Luca Visani
- Department of Medical Physics and Radiation Oncology, IFCA, Florence, Italy; Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi Florence, Italy; Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi Florence, Italy; Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| |
Collapse
|
10
|
Stapper C, Gerlach S, Hofmann T, Fürweger C, Schlaefer A. Automated isocenter optimization approach for treatment planning for gyroscopic radiosurgery. Med Phys 2023; 50:5212-5221. [PMID: 37099483 DOI: 10.1002/mp.16436] [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: 11/25/2022] [Revised: 03/13/2023] [Accepted: 04/12/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Radiosurgery is a well-established treatment for various intracranial tumors. In contrast to other established radiosurgery platforms, the new ZAP-X® allows for self-shielding gyroscopic radiosurgery. Here, treatment beams with variable beam-on times are targeted towards a small number of isocenters. The existing planning framework relies on a heuristic based on random selection or manual selection of isocenters, which often leads to a higher plan quality in clinical practice. PURPOSE The purpose of this work is to study an improved approach for radiosurgery treatment planning, which automatically selects the isocenter locations for the treatment of brain tumors and diseases in the head and neck area using the new system ZAP-X® . METHODS We propose a new method to automatically obtain the locations of the isocenters, which are essential in gyroscopic radiosurgery treatment planning. First, an optimal treatment plan is created based on a randomly selected nonisocentric candidate beam set. The intersections of the resulting subset of weighted beams are then clustered to find isocenters. This approach is compared to sphere-packing, random selection, and selection by an expert planner for generating isocenters. We retrospectively evaluate plan quality on 10 acoustic neuroma cases. RESULTS Isocenters acquired by the method of clustering result in clinically viable plans for all 10 test cases. When using the same number of isocenters, the clustering approach improves coverage on average by 31 percentage points compared to random selection, 15 percentage points compared to sphere packing and 2 percentage points compared to the coverage achieved with the expert selected isocenters. The automatic determination of location and number of isocenters leads, on average, to a coverage of 97 ± 3% with a conformity index of 1.22 ± 0.22, while using 2.46 ± 3.60 fewer isocenters than manually selected. In terms of algorithm performance, all plans were calculated in less than 2 min with an average runtime of 75 ± 25 s. CONCLUSIONS This study demonstrates the feasibility of an automatic isocenter selection by clustering in the treatment planning process with the ZAP-X® system. Even in complex cases where the existing approaches fail to produce feasible plans, the clustering method generates plans that are comparable to those produced by expert selected isocenters. Therefore, our approach can help reduce the effort and time required for treatment planning in gyroscopic radiosurgery.
Collapse
Affiliation(s)
- Carolin Stapper
- Institute of Medical Technology and Intelligent Systems, Hamburg University of Technology, Hamburg, Germany
| | - Stefan Gerlach
- Institute of Medical Technology and Intelligent Systems, Hamburg University of Technology, Hamburg, Germany
| | | | | | - Alexander Schlaefer
- Institute of Medical Technology and Intelligent Systems, Hamburg University of Technology, Hamburg, Germany
| |
Collapse
|
11
|
Hindley N, Shieh CC, Keall P. A patient-specific deep learning framework for 3D motion estimation and volumetric imaging during lung cancer radiotherapy. Phys Med Biol 2023; 68:14NT01. [PMID: 37364571 DOI: 10.1088/1361-6560/ace1d0] [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: 02/17/2023] [Accepted: 06/26/2023] [Indexed: 06/28/2023]
Abstract
Objective. Respiration introduces a constant source of irregular motion that poses a significant challenge for the precise irradiation of thoracic and abdominal cancers. Current real-time motion management strategies require dedicated systems that are not available in most radiotherapy centers. We sought to develop a system that estimates and visualises the impact of respiratory motion in 3D given the 2D images acquired on a standard linear accelerator.Approach. In this paper we introduceVoxelmap, a patient-specific deep learning framework that achieves 3D motion estimation and volumetric imaging using the data and resources available in standard clinical settings. Here we perform a simulation study of this framework using imaging data from two lung cancer patients.Main results. Using 2D images as input and 3D-3DElastixregistrations as ground-truth,Voxelmapwas able to continuously predict 3D tumor motion with mean errors of 0.1 ± 0.5, -0.6 ± 0.8, and 0.0 ± 0.2 mm along the left-right, superior-inferior, and anterior-posterior axes respectively.Voxelmapalso predicted 3D thoracoabdominal motion with mean errors of -0.1 ± 0.3, -0.1 ± 0.6, and -0.2 ± 0.2 mm respectively. Moreover, volumetric imaging was achieved with mean average error 0.0003, root-mean-squared error 0.0007, structural similarity 1.0 and peak-signal-to-noise ratio 65.8.Significance. The results of this study demonstrate the possibility of achieving 3D motion estimation and volumetric imaging during lung cancer treatments on a standard linear accelerator.
Collapse
Affiliation(s)
| | - Chun-Chien Shieh
- Image X Institute, University of Sydney, Sydney, NSW, Australia
- Sydney Neuroimaging Analysis Centre, University of Sydney, Sydney, Australia
| | - Paul Keall
- Image X Institute, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
12
|
Liang ZW, Zhai ML, Tu B, Nie X, Zhu XH, Cheng JP, Li GQ, Yu DD, Zhang T, Zhang S. Comprehensive Treatment Uncertainty Analysis and PTV Margin Estimation for Fiducial Tracking in Robotic Liver Stereotactic Body Radiation Therapy. Curr Med Sci 2023:10.1007/s11596-023-2717-6. [PMID: 37142817 DOI: 10.1007/s11596-023-2717-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/09/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE This study aims to quantify the uncertainties of CyberKnife Synchrony fiducial tracking for liver stereotactic body radiation therapy (SBRT) cases, and evaluate the required planning target volume (PTV) margins. METHODS A total of 11 liver tumor patients with a total of 57 fractions, who underwent SBRT with synchronous fiducial tracking, were enrolled for the present study. The correlation/prediction model error, geometric error, and beam targeting error were quantified to determine the patient-level and fraction-level individual composite treatment uncertainties. The composite uncertainties and multiple margin recipes were compared for scenarios with and without rotation correction during treatment. RESULTS The correlation model error-related uncertainty was 4.3±1.8, 1.4±0.5 and 1.8±0.7 mm in the superior-inferior (SI), left-right, and anterior-posterior directions, respectively. These were the primary contributors among all uncertainty sources. The geometric error significantly increased for treatments without rotation correction. The fraction-level composite uncertainties had a long tail distribution. Furthermore, the generally used 5-mm isotropic margin covered all uncertainties in the left-right and anterior-posterior directions, and only 75% of uncertainties in the SI direction. In order to cover 90% of uncertainties in the SI direction, an 8-mm margin would be needed. For scenarios without rotation correction, additional safety margins should be added, especially in the superior-inferior and anterior-posterior directions. CONCLUSION The present study revealed that the correlation model error contributes to most of the uncertainties in the results. Most patients/fractions can be covered by a 5-mm margin. Patients with large treatment uncertainties might need a patient-specific margin.
Collapse
Affiliation(s)
- Zhi-Wen Liang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Meng-Lan Zhai
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Biao Tu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xin Nie
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiao-Hui Zhu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jun-Ping Cheng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Guo-Quan Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Dan-Dan Yu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Tao Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Sheng Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| |
Collapse
|
13
|
Crop F, Laffarguette J, Achag I, Pasquier D, Mirabel X, Cayez R, Lacornerie T. Evaluation of surface image guidance and Deep inspiration Breath Hold technique for breast treatments with Halcyon. Phys Med 2023; 108:102564. [PMID: 36989980 DOI: 10.1016/j.ejmp.2023.102564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/13/2022] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
PURPOSE To evaluate the accuracy/agreement of a three-camera Catalyst Surface Guided Radiation Therapy (SGRT) system on a closed-gantry Halcyon for Free-Breathing (FB) and Deep Inspiration Breath Hold (DIBH) breast-only treatments. METHODS The SGRT positioning agreement with Halcyon couch and cone-beam computed tomography (CBCT) was evaluated on phantom and by evaluation of 2401 FB and 855 DIBH breast-only treatment sessions. The DIBH agreement was evaluated using a programmable moving support. Dose agreement was evaluated for manual SGRT-assisted beam interruption and Halcyon arc beam interruption. RESULTS Geometrical phantom agreement was < 0.4 mm. Couch and SGRT agreement for an anthropomorphic phantom resulted in 95% limits of agreement in Right-Left/Feet-Head/Posterior-Anterior (RL/FH/PA) directions of respectively ± 0.4/0.8/0.5 mm and ± 1.1/1.1/0.6 mm in the virtual and real isocenter. FB-SGRT-assisted patient positioning compared to CBCT positioning resulted in RL/FH/PA systematic differences of -0.1/0.1/2.0 mm with standard deviations of 2.7/2.8/2.4 mm. This mean systematic difference had three origins: a) couch sag/isocenter difference of ≤ 0.5 mm. b) Average reconstructed FB-CBCT images do not visually represent the average respiratory position. c) CBCT-based positioning focused on the inner thoracic interface, which can introduce a mean positioning difference between SGRT and CBCT. Manual SGRT-assisted beam interruption and arc interruptions resulted in mean gamma passing rates > 97% (0.5%/0.5 mm) and mean absolute differences < 0.3%. CONCLUSIONS Accuracy was comparable with breast-only C-arm SGRT techniques, with different tradeoffs. Depending on the patient's morphology, real-time tracking accuracy in the real isocenter can be reduced. This study demonstrates possible discordances between SGRT and CBCT positioning for breast.
Collapse
|
14
|
Chen Q, Rong Y, Burmeister JW, Chao EH, Corradini NA, Followill DS, Li XA, Liu A, Qi XS, Shi H, Smilowitz JB. AAPM Task Group Report 306: Quality control and assurance for tomotherapy: An update to Task Group Report 148. Med Phys 2023; 50:e25-e52. [PMID: 36512742 DOI: 10.1002/mp.16150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/22/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Since the publication of AAPM Task Group (TG) 148 on quality assurance (QA) for helical tomotherapy, there have been many new developments on the tomotherapy platform involving treatment delivery, on-board imaging options, motion management, and treatment planning systems (TPSs). In response to a need for guidance on quality control (QC) and QA for these technologies, the AAPM Therapy Physics Committee commissioned TG 306 to review these changes and make recommendations related to these technology updates. The specific objectives of this TG were (1) to update, as needed, recommendations on tolerance limits, frequencies and QC/QA testing methodology in TG 148, (2) address the commissioning and necessary QA checks, as a supplement to Medical Physics Practice Guidelines (MPPG) with respect to tomotherapy TPS and (3) to provide risk-based recommendations on the new technology implemented clinically and treatment delivery workflow. Detailed recommendations on QA tests and their tolerance levels are provided for dynamic jaws, binary multileaf collimators, and Synchrony motion management. A subset of TPS commissioning and QA checks in MPPG 5.a. applicable to tomotherapy are recommended. In addition, failure mode and effects analysis has been conducted among TG members to obtain multi-institutional analysis on tomotherapy-related failure modes and their effect ranking.
Collapse
Affiliation(s)
- Quan Chen
- Radiation Oncology, City of Hope Medical Center, Duarte, California, USA
| | - Yi Rong
- Department of Radiation Oncology, Mayo Clinic Hospitals, Phoenix, Arizona, USA
| | - Jay W Burmeister
- Karmanos Cancer Center, Gershenson R.O.C., Detroit, Michigan, USA
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | | | - David S Followill
- Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - X Allen Li
- Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - An Liu
- Radiation Oncology, City of Hope Medical Center, Duarte, California, USA
| | - X Sharon Qi
- Radiation Oncology, UCLA School of Medicine, Los Angeles, California, USA
| | - Hairong Shi
- Radiation Oncology, Oklahoma Cancer Specialists and Research Institute, Tulsa, Oklahoma, USA
| | - Jennifer B Smilowitz
- Human Oncology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
15
|
Srivastava SP, Sorensen SP, Jani SS, Yan X, Pinnaduwage DS. Machine performance and stability of the first clinical self-shielded stereotactic radiosurgery system: Initial 2-year experience. J Appl Clin Med Phys 2023; 24:e13857. [PMID: 36519493 PMCID: PMC10018673 DOI: 10.1002/acm2.13857] [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: 07/08/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
This study provides insight into the overall system performance, stability, and delivery accuracy of the first clinical self-shielded stereotactic radiosurgery (SRS) system. Quality assurance procedures specifically developed for this unit are discussed, and trends and variations over the course of 2-years for beam constancy, targeting and dose delivery are presented. Absolute dose calibration for this 2.7 MV unit is performed to deliver 1 cGy/MU at dmax = 7 mm at a source-to-axis-distance (SAD) of 450 mm for a 25 mm collimator. Output measurements were made with 2-setups: a device that attaches to a fixed position on the couch (daily) and a spherical phantom that attaches to the collimating wheel (monthly). Beam energy was measured using a cylindrical acrylic phantom at depths of 100 (D10 ) and 200 (D20 ) mm. Beam profiles were evaluated using Gafchromic film and compared with TPS beam data. Accuracy in beam targeting was quantified with the Winston-Lutz (WL) and end-to-end (E2E) tests. Delivery quality assurance (DQA) was performed prior to clinical treatments using Gafchromic EBT3/XD film. Net cumulative output adjustments of 15% (pre-clinical), 9% (1st year) and 3% (2nd year) were made. The mean output was 0.997 ± 0.010 cGy/MU (range: 0.960-1.046 cGy/MU) and 0.993 ± 0.029 cGy/MU (range: 0.884-1.065 cGy/MU) for measurements with the daily and monthly setups, respectively. The mean relative beam energy (D10 /D20 ) was 0.998 ± 0.004 (range: 0.991-1.006). The mean total targeting error was 0.46 ± 0.17 mm (range: 0.06-0.98 mm) for the WL and 0.52 ± 0.28 mm (range: 0.11-1.27 mm) for the E2E tests. The average gamma pass rates for DQA measurements were 99.0% and 90.5% for 2%/2 mm and 2%/1 mm gamma criteria, respectively. This SRS unit meets tolerance limits recommended by TG-135, MPPG 9a., and TG-142 with a treatment delivery accuracy similar to what is achieved by other SRS systems.
Collapse
Affiliation(s)
- Shiv P Srivastava
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Stephen P Sorensen
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Shyam S Jani
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Xiangsheng Yan
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Dilini S Pinnaduwage
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| |
Collapse
|
16
|
Small field output factor measurement and verification for CyberKnife robotic radiotherapy and radiosurgery system using 3D polymer gel, ionization chamber, diode, diamond and scintillator detectors, Gafchromic film and Monte Carlo simulation. Appl Radiat Isot 2023; 192:110576. [PMID: 36473319 DOI: 10.1016/j.apradiso.2022.110576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
The dosimetry of small fields has become tremendously important with the advent of intensity-modulated radiation therapy (IMRT) and stereotactic radiosurgery, where small field segments or very small fields are used to treat tumors. With high dose gradients in the stereotactic radiosurgery or radiotherapy treatment, small field dosimetry becomes challenging due to the lack of lateral electronic equilibrium in the field, x-ray source occlusion, and detector volume averaging. Small volume and tissue-equivalent detectors are recommended to overcome the challenges. With the lack of a perfect radiation detector, studies on available detectors are ongoing with reasonable disagreement and uncertainties. The joint IAEA and AAPM international code of practice (CoP) for small field dosimetry, TRS 483 (Alfonso et al., 2017) provides guidelines and recommendations for the dosimetry of small static fields in external beam radiotherapy. The CoP provides a methodology for field output factor (FOF) measurements and use of field output correction factors for a series of small field detectors and strongly recommends additional measurements, data collection and verification for CyberKnife (CK) robotic stereotactic radiotherapy/radiosurgery system using the listed detectors and more new detectors so that the FOFs can be implemented clinically. The present investigation is focused on using 3D gel along with some other commercially available detectors for the measurement and verification of field output factors (FOFs) for the small fields available in the CK system. The FOF verification was performed through a comparison with published data and Monte Carlo simulation. The results of this study have proved the suitability of an in-house developed 3D polymer gel dosimeter, several commercially available detectors, and Gafchromic films as a part of small field dosimetric measurements for the CK system.
Collapse
|
17
|
Le Reun E, Casutt A, Durham A, Bouchaab H, Romano E, Lovis A, Krueger T, Von Garnier C, Özsahin EM, Kinj R. Lung stereotactic radiation therapy: Intercomparison of irradiation devices in terms of outcome and predictive factors. Cancer Radiother 2023; 27:31-41. [PMID: 35965243 DOI: 10.1016/j.canrad.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/07/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare three different radiotherapy devices able to perform pulmonary stereotactic radiotherapy: CyberKnife® (CK), Helical Tomotherapy® (HT), and volumetric modulated arc therapy (VMAT). This study aims to define the patients' outcome in terms of SBRT efficacy and toxicities depending of the device choice. MATERIALS AND METHODS We retrospectively analyzed the clinical, radiological, and dosimetric data of patients treated with lung SBRT between 2016 and 2020 at Lausanne University Hospital, using the Chi2 test for proportions, the t-test for means comparisons, the Kaplan-Meier method for survival, and the Log-rank test and Cox-regression for intergroups comparisons. RESULTS We identified 111 patients treated by either CK (59.9%), VMAT (38.0%), or HT (2.1%). Compared to other techniques, CK treated comparable gross tumor volume (GTV; 2.1 vs. 1.4cm3, P=0.84) with smaller planning treatment volume (PTV; 12.3 vs. 21.9cm3, P=0.013) and lower V5 (13.5 vs. 19.9cm3, P=0.002). Local control rates at 2years were not different whatever the irradiation device, respectively of 96.2% (range, 90.8-100) and 98.1% (range, 94.4-100), P=0.68. Toxicity incidence significantly increased with V5 value>17.2% (56.0 vs. 77.4%, P=0.021). CONCLUSION Compared to other SBRT techniques, CK treatments permitted to treat comparable GTV with reduced PTV and V5. Toxicity incidence was less frequent when reducing the V5. CK is particularly attractive in case of multiple courses of lung SBRT or lung reirradiation.
Collapse
Affiliation(s)
- E Le Reun
- Department of Radiation Oncology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland; Institut national de la santé et de la recherche médicale (Inserm), U1296 Research Unit « Radiations: Defense, Health and Environment », centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - A Casutt
- Division of Pulmonology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland; Lausanne University (UNIL), Lausanne, Switzerland
| | - A Durham
- Department of Radiation Oncology, University Hospital of Genève (HUG), rue Gabrielle-Perret-Gentil, 1205 Genève, Switzerland
| | - H Bouchaab
- Department of Medical Oncology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - E Romano
- Department of Radiation Oncology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - A Lovis
- Division of Pulmonology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland; Lausanne University (UNIL), Lausanne, Switzerland
| | - T Krueger
- Department of Thoracic Surgery, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - C Von Garnier
- Division of Pulmonology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland; Lausanne University (UNIL), Lausanne, Switzerland
| | - E M Özsahin
- Department of Radiation Oncology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - R Kinj
- Department of Radiation Oncology, University Hospital Center of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland.
| |
Collapse
|
18
|
Mizonobe K, Akasaka H, Uehara K, Oki Y, Nakayama M, Tamura S, Munetomo Y, Kubo K, Kawaguchi H, Harada A, Mayahara H. Respiratory motion tracking of spine stereotactic radiotherapy in prone position. J Appl Clin Med Phys 2023; 24:e13910. [PMID: 36650923 PMCID: PMC10161010 DOI: 10.1002/acm2.13910] [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: 07/11/2022] [Revised: 10/18/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The CyberKnife system is a specialized device for non-coplanar irradiation; however, it possesses the geometric restriction that the beam cannot be irradiated from under the treatment couch. Prone positioning is expected to reduce the dose to normal lung tissue in spinal stereotactic body radiotherapy (SBRT) owing to the efficiency of beam arrangement; however, respiratory motion occurs. Therefore, the Xsight spine prone tracking (XSPT) system is used to reduce the effects of respiratory motion. The purpose of this study was to evaluate the motion-tracking error of the spine in the prone position. MATERIALS AND METHODS Data from all 25 patients who underwent spinal SBRT at our institution between April 2020 and February 2022 using CyberKnife (VSI, version 11.1.0) with the XSPT tracking system were retrospectively analyzed using log files. The tumor motion, correlation, and prediction errors for each patient were examined. Furthermore, to assess the potential relationships between the parameters, the relationships between the tumor-motion amplitudes and correlation or prediction errors were investigated using linear regression. RESULTS The tumor-motion amplitudes in each direction were as follows: superior-inferior (SI), 0.51 ± 0.39 mm; left-right (LR), 0.37 ± 0.29 mm; and anterior-posterior (AP), 3.43 ± 1.63 mm. The overall mean correlation and prediction errors were 0.66 ± 0.48 mm and 0.06 ± 0.07 mm, respectively. The prediction errors were strongly correlated with the tumor-motion amplitudes, whereas the correlation errors were not. CONCLUSIONS This study demonstrated that the correlation error of spinal SBRT in the prone position is sufficiently small to be independent of the tumor-motion amplitude. Furthermore, the prediction error is small, contributing only slightly to the tracking error. These findings will improve the understanding of how to compensate for respiratory-motion uncertainty in the prone position.
Collapse
Affiliation(s)
- Kazufusa Mizonobe
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Hiroaki Akasaka
- Department of Chemical Engineering, The University of Melbourne, The University of Melbourne Grattan Street, Parkville, Victoria, Australia.,Division of Radiation Oncology, Kobe University Graduate School of Medicine, Chuou-ku, Kobe, Hyogo, Japan
| | - Kazuyuki Uehara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Yuya Oki
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Masao Nakayama
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Chuou-ku, Kobe, Hyogo, Japan.,Division of Radiation Therapy, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Shuhei Tamura
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Yoshiki Munetomo
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Katsumaro Kubo
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Hiroki Kawaguchi
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Aya Harada
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Hiroshi Mayahara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| |
Collapse
|
19
|
Shakarami Z, Broggi S, Vecchio AD, Fiorino C, Spinelli AE. Radioluminescence imaging feasibility for robotic radiosurgery field size quality assurance. Med Phys 2022; 49:6588-6598. [PMID: 35946490 DOI: 10.1002/mp.15914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To investigate the feasibility of radioluminescence imaging (RLI) as a novel 2D quality assurance (QA) dosimetry system for CyberKnife®. METHODS We developed a field size measurement system based on a commercial complementary metal oxide semiconductor (CMOS) camera facing a radioluminescence screen located at the isocenter normal to the beam axis. The radioluminescence light collected by a lens was used to measure 2D dose distributions. An image transformation procedure, based on two reference phantoms, was developed to correct for projective distortion due to the angle (15°) between the optical and beam axis. Dose profiles were measured for field sizes ranging from 5 mm to 60 mm using fixed circular and iris collimators and compared against gafchromic (GC) film. The corresponding full width at half maximum (FWHM) was measured using RLI and benchmarked against GC film. A small shift in the source-to-surface distance (SSD) of the measurement plane was intentionally introduced to test the sensitivity of the RLI system to field size variations. To assess reproducibility, the entire RLI procedure was tested by acquiring the 60 mm circle field three times on two consecutive days. RESULTS The implemented procedure for perspective image distortion correction showed improvements of up to 1 mm using the star phantom against the square phantom. The FWHM measurements using the RLI system indicated a strong agreement with GC film with maximum absolute difference equal to 0.131 mm for fixed collimators and 0.056 mm for the iris. A 2D analysis of RLI with respect to GC film showed that the differences in the central region are negligible, while small discrepancies are in the penumbra region. Changes in field sizes of 0.2 mm were detectable by RLI. Repeatability measurements of the beam FWHM have shown a standard deviation equal to 0.11 mm. CONCLUSIONS The first application of a RLI approach for CyberKnife® field size measurement was presented and tested. Results are in agreement with GC film measurements. Spatial resolution and immediate availability of the data indicate that RLI is a feasible technique for robotic radiosurgery QA.
Collapse
Affiliation(s)
- Zahra Shakarami
- Experimental Imaging Centre, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Sara Broggi
- Medical Physics Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Antonella Del Vecchio
- Medical Physics Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Claudio Fiorino
- Medical Physics Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Antonello E Spinelli
- Experimental Imaging Centre, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| |
Collapse
|
20
|
Hewson EA, Nguyen DT, Le A, Booth JT, Keall PJ, Mejnertsen L. Optimising multi-target multileaf collimator tracking using real-time dose for locally advanced prostate cancer patients. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac8967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. The accuracy of radiotherapy for patients with locally advanced cancer is compromised by independent motion of multiple targets. To date, MLC tracking approaches have used 2D geometric optimisation where the MLC aperture shape is simply translated to correspond to the target’s motion, which results in sub-optimal delivered dose. To address this limitation, a dose-optimised multi-target MLC tracking method was developed and evaluated through simulated locally advanced prostate cancer treatments. Approach. A dose-optimised multi-target tracking algorithm that adapts the MLC aperture to minimise 3D dosimetric error was developed for moving prostate and static lymph node targets. A fast dose calculation algorithm accumulated the planned dose to the prostate and lymph node volumes during treatment in real time, and the MLC apertures were recalculated to minimise the difference between the delivered and planned dose with the included motion. Dose-optimised tracking was evaluated by simulating five locally advanced prostate plans and three prostate motion traces with a relative interfraction displacement. The same simulations were performed using geometric-optimised tracking and no tracking. The dose-optimised, geometric-optimised, and no tracking results were compared with the planned doses using a 2%/2 mm γ criterion. Main results. The mean dosimetric error was lowest for dose-optimised MLC tracking, with γ-failure rates of 12% ± 8.5% for the prostate and 2.2% ± 3.2% for the nodes. The γ-failure rates for geometric-optimised MLC tracking were 23% ± 12% for the prostate and 3.6% ± 2.5% for the nodes. When no tracking was used, the γ-failure rates were 37% ± 28% for the prostate and 24% ± 3.2% for the nodes. Significance. This study developed a dose-optimised multi-target MLC tracking method that minimises the difference between the planned and delivered doses in the presence of intrafraction motion. When applied to locally advanced prostate cancer, dose-optimised tracking showed smaller errors than geometric-optimised tracking and no tracking for both the prostate and nodes.
Collapse
|
21
|
Ninni S, Gallot-Lavallée T, Klein C, Longère B, Brigadeau F, Potelle C, Crop F, Rault E, Decoene C, Lacornerie T, Lals S, Kouakam C, Pontana F, Lacroix D, Klug D, Mirabel X. Stereotactic Radioablation for Ventricular Tachycardia in the Setting of Electrical Storm. Circ Arrhythm Electrophysiol 2022; 15:e010955. [PMID: 36074658 DOI: 10.1161/circep.122.010955] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) has been reported as a safe and efficient therapy for treating refractory ventricular tachycardia (VT) despite optimal medical treatment and catheter ablation. However, data on the use of SBRT in patients with electrical storm (ES) is lacking. The aim of this study was to assess the clinical outcomes associated with SBRT in the context of ES. METHODS This retrospective study included patients who underwent SBRT in the context of ES from March 2020 to March 2021 in one tertiary center (CHU Lille). The target volume was delineated according to a predefined workflow. The efficacy was assessed with the following end points: sustained VT recurrence, VT reduced with antitachycardia pacing, and implantable cardioverter defibrillator shock. RESULTS Seventeen patients underwent SBRT to treat refractory VT in the context of ES (mean 67±12.8 age, 59% presenting ischemic heart disease, mean left ventricular ejection fraction: 33.7± 9.7%). Five patients presented with ES related to incessant VT. Among these 5 patients, the time to effectiveness ranged from 1 to 7 weeks after SBRT. In the 12 remaining patients, VT recurrences occurred in 7 patients during the first 6 weeks following SBRT. After a median 12.5 (10.5-17.8) months follow-up, a significant reduction of the VT burden was observed beyond 6 weeks (-91% [95% CI, 78-103]), P<0.0001). The incidence of implantable cardioverter defibrillator shock and antitachycardia pacing was 36% at 1 year. CONCLUSIONS SBRT is associated with a significant reduction of the VT burden in the event of an ES; however, prospective randomized control trials are needed. In patients without incessant VT, recurrences are observed in half of patients during the first 6 weeks. VT tolerance and implantable cardioverter defibrillator programming adjustments should be integrated as part of an action plan defined before SBRT for each patient.
Collapse
Affiliation(s)
- Sandro Ninni
- CHU Lille, Institut Cœur-Poumon, Service de Cardiologie (S.N., T.G.L., C.K., F.B., C.K., D.L., D.K.)
| | - Thomas Gallot-Lavallée
- CHU Lille, Institut Cœur-Poumon, Service de Cardiologie (S.N., T.G.L., C.K., F.B., C.K., D.L., D.K.)
| | - Cédric Klein
- CHU Lille, Institut Cœur-Poumon, Service de Cardiologie (S.N., T.G.L., C.K., F.B., C.K., D.L., D.K.)
| | - Benjamin Longère
- CHU Lille, Institut Cœur-Poumon, Service De Radiologie (B.L., F.P.)
| | - François Brigadeau
- CHU Lille, Institut Cœur-Poumon, Service de Cardiologie (S.N., T.G.L., C.K., F.B., C.K., D.L., D.K.)
| | | | - Frederik Crop
- University Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center (F.C., E.R., C.D., T.L., S.L.).,Medical Physics, Centre Oscar Lambret, Lille, France (F.C., E.R., C.D., T.L.)
| | - Erwann Rault
- University Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center (F.C., E.R., C.D., T.L., S.L.).,Medical Physics, Centre Oscar Lambret, Lille, France (F.C., E.R., C.D., T.L.)
| | - Camille Decoene
- University Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center (F.C., E.R., C.D., T.L., S.L.).,Medical Physics, Centre Oscar Lambret, Lille, France (F.C., E.R., C.D., T.L.)
| | - Thomas Lacornerie
- University Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center (F.C., E.R., C.D., T.L., S.L.).,Medical Physics, Centre Oscar Lambret, Lille, France (F.C., E.R., C.D., T.L.)
| | - Séverine Lals
- University Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center (F.C., E.R., C.D., T.L., S.L.)
| | - Claude Kouakam
- CHU Lille, Institut Cœur-Poumon, Service de Cardiologie (S.N., T.G.L., C.K., F.B., C.K., D.L., D.K.)
| | - François Pontana
- CHU Lille, Institut Cœur-Poumon, Service De Radiologie (B.L., F.P.)
| | - Dominique Lacroix
- CHU Lille, Institut Cœur-Poumon, Service de Cardiologie (S.N., T.G.L., C.K., F.B., C.K., D.L., D.K.)
| | - Didier Klug
- CHU Lille, Institut Cœur-Poumon, Service de Cardiologie (S.N., T.G.L., C.K., F.B., C.K., D.L., D.K.)
| | | |
Collapse
|
22
|
Church C, Parsons D, Syme A. Region-of-interest intra-arc MV imaging to facilitate sub-mm positional accuracy with minimal imaging dose during treatment deliveries of small cranial lesions. J Appl Clin Med Phys 2022; 23:e13769. [PMID: 36052995 PMCID: PMC9680576 DOI: 10.1002/acm2.13769] [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: 04/04/2022] [Revised: 07/15/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To automate the generation of region‐of‐interest (ROI) apertures for use with megavoltage imaging for online positional corrections during cranial stereotactic radiosurgery. Materials and methods Digitally reconstructed radiographs (DRRs) were created for a 3D‐printed skull phantom at 5 degree gantry angle increments for a three‐arc beam arrangement. At each angle, 3000 random rectangular apertures were generated, and 100 shifts on a grid were applied to the anatomy within the frame. For all shifts, the mutual information (MI) between the shifted and unshifted DRR was calculated to derive an average MI gradient. The top 10% of apertures that minimized registration errors were overlaid and discretely thresholded to generate imaging plans. Imaging was acquired with the skull while implementing simulated patient motion on a linac. Control point‐specific couch motions were derived to align the skull to its planned positioning. Results Apertures with a range of repositioning errors less than 0.1 mm possessed a 42% larger average MI gradient when compared with apertures with a range greater than 1 mm. Dose calculations with Monte Carlo exhibited an 84% reduction in the dose received by 50% of the skull with the 50% thresholded plan when compared to a constant 22 × 22 cm2 imaging plan. For all different imaging plans (with and without motion), the calculated median 3D‐errors with respect to the tracking of a metal‐BB fiducial positioned at isocenter in the skull were sub‐mm except for the 80% thresholded plan. Conclusions Sub‐mm positional errors are achievable with couch motions derived from control point–specific ROI imaging. Smaller apertures that conform to an anatomical ROI can be utilized to minimize the imaging dose incurred at the expense of larger errors.
Collapse
Affiliation(s)
- Cody Church
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Parsons
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alasdair Syme
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
23
|
Connolly L, Deguet A, Leonard S, Tokuda J, Ungi T, Krieger A, Kazanzides P, Mousavi P, Fichtinger G, Taylor RH. Bridging 3D Slicer and ROS2 for Image-Guided Robotic Interventions. SENSORS (BASEL, SWITZERLAND) 2022; 22:5336. [PMID: 35891016 PMCID: PMC9324680 DOI: 10.3390/s22145336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
Developing image-guided robotic systems requires access to flexible, open-source software. For image guidance, the open-source medical imaging platform 3D Slicer is one of the most adopted tools that can be used for research and prototyping. Similarly, for robotics, the open-source middleware suite robot operating system (ROS) is the standard development framework. In the past, there have been several "ad hoc" attempts made to bridge both tools; however, they are all reliant on middleware and custom interfaces. Additionally, none of these attempts have been successful in bridging access to the full suite of tools provided by ROS or 3D Slicer. Therefore, in this paper, we present the SlicerROS2 module, which was designed for the direct use of ROS2 packages and libraries within 3D Slicer. The module was developed to enable real-time visualization of robots, accommodate different robot configurations, and facilitate data transfer in both directions (between ROS and Slicer). We demonstrate the system on multiple robots with different configurations, evaluate the system performance and discuss an image-guided robotic intervention that can be prototyped with this module. This module can serve as a starting point for clinical system development that reduces the need for custom interfaces and time-intensive platform setup.
Collapse
Affiliation(s)
- Laura Connolly
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; (A.D.); (S.L.); (A.K.); (P.K.); (R.H.T.)
- School of Computing, Queen’s University, Kingston, ON K7L 3N6, Canada; (T.U.); (P.M.); (G.F.)
| | - Anton Deguet
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; (A.D.); (S.L.); (A.K.); (P.K.); (R.H.T.)
| | - Simon Leonard
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; (A.D.); (S.L.); (A.K.); (P.K.); (R.H.T.)
| | | | - Tamas Ungi
- School of Computing, Queen’s University, Kingston, ON K7L 3N6, Canada; (T.U.); (P.M.); (G.F.)
| | - Axel Krieger
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; (A.D.); (S.L.); (A.K.); (P.K.); (R.H.T.)
| | - Peter Kazanzides
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; (A.D.); (S.L.); (A.K.); (P.K.); (R.H.T.)
| | - Parvin Mousavi
- School of Computing, Queen’s University, Kingston, ON K7L 3N6, Canada; (T.U.); (P.M.); (G.F.)
| | - Gabor Fichtinger
- School of Computing, Queen’s University, Kingston, ON K7L 3N6, Canada; (T.U.); (P.M.); (G.F.)
| | - Russell H. Taylor
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; (A.D.); (S.L.); (A.K.); (P.K.); (R.H.T.)
| |
Collapse
|
24
|
Moutsatsos A, Kouris P, Zoros M, Athanasiou O, Koutsarnakis C, Pantelakos P, Pantelis E. On the effect of dose delivery temporal domain on the biological effectiveness of central nervous system CyberKnife radiosurgery applications: theoretical assessment using the concept of biologically effective dose. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac783b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/13/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective: The diversity in technical configuration between clinically available radiosurgery systems, results in accordingly diverse treatment times for the same physical dose prescription, spanning from several min to more than 1 h. This, combined with evidence supporting the impact of dose delivery temporal pattern on the bio-effectiveness of low-LET radiation treatments, challenges the ‘acute exposure’ assumption adopted clinically to estimate the biological outcome of a given treatment scheme under the concept of biologically effective dose (BED). Approach: In this work, the treatment plans of 30 patients underwent CyberKnife radiosurgery for vestibular schwannoma (VS), prescribing a marginal dose of 13 Gy to the tumor, were retrospectively reviewed and the corresponding dose distributions were resolved in the temporal domain. For this purpose, the dose delivery timeline for each treatment was calculated based on relevant treatment plan data and technical specifications of the CyberKnife system, while dosimetry data were independently acquired on a CT-based digital model of each patient using an in-house developed dose calculation algorithm. Main results: Results showed that CyberKnife delivers highly inhomogeneous dose rate distributions in the temporo-spatial domain. This influences the delivered BED levels due to alterations in the sublethal damage repair (SLR) occurring within the treatment session. Using a BED framework involving SLR effects, it was shown that each physical dose iso-surface is associated with a BEDslr range. For the patient cohort studied, a typical range of 2%, with respect to the mean BEDslr value was found at 1σ. Significance: The marginal BEDslr delivered to the tumor by the prescription dose iso-surface deteriorates with treatment time, involving both beam-on time and beam-off gaps. For treatment time, T, between 21 and 50 min, this can be expressed by
BED
slr
(
Gy
2.47
)
=
−
0.35
±
2.8
%
∙
T
min
+
(
76.74
±
0.4
%
)
.
Compared to the acute exposure approach, a BED ‘loss’ of 21% is associated with the delivery of 13 Gy to the VS-tumor in 35 min.
Collapse
|
25
|
Kawabata F, Kamomae T, Okudaira K, Komori M, Oguchi H, Sasaki M, Mori M, Kawamura M, Abe S, Ishihara S, Naganawa S. Development of a high-resolution two-dimensional detector-based dose verification system for tumor-tracking irradiation in the CyberKnife system. J Appl Clin Med Phys 2022; 23:e13645. [PMID: 35789532 PMCID: PMC9359009 DOI: 10.1002/acm2.13645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/16/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
We aim to evaluate the basic characteristics of SRS MapCHECK (SRSMC) for CyberKnife (CK) and establish a dose verification system using SRSMC for the tumor‐tracking irradiation for CK. The field size and angular dependence of SRSMC were evaluated for basic characterization. The output factors (OPFs) and absolute doses measured by SRSMC were compared with those measured using microDiamond and microchamber detectors and those calculated by the treatment planning system (TPS). The angular dependence was evaluated by comparing the SRSMC with a microchamber. The tumor‐tracking dose verification system consists of SRSMC and a moving platform. The doses measured using SRSMC were compared with the doses measured using a microchamber and radiochromic film. The OPFs and absolute doses of SRSMC were within ±3.0% error for almost all field sizes, and the angular dependence was within ±2.0% for all incidence angles. The absolute dose errors between SRSMC and TPS tended to increase when the field size was smaller than 10 mm. The absolute doses of the tumor‐tracking irradiation measured using SRSMC and those measured using a microchamber agreed within 1.0%, and the gamma pass rates of SRSMC in comparison with those of the radiochromic film were greater than 95%. The basic characteristics of SRSMC for CK presented acceptable results for clinical use. The results of the tumor‐tracking dose verification system realized using SRSMC were equivalent to those of conventional methods, and this system is expected to contribute toward improving the efficiency of quality control in many facilities.
Collapse
Affiliation(s)
- Fumitaka Kawabata
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Takeshi Kamomae
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kuniyasu Okudaira
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Masataka Komori
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroshi Oguchi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Motoharu Sasaki
- Department of Therapeutic Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Masaki Mori
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji Abe
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Shunichi Ishihara
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| |
Collapse
|
26
|
Milder MT, Magallon-Baro A, den Toom W, de Klerck E, Luthart L, Nuyttens JJ, Hoogeman MS. Technical feasibility of online adaptive stereotactic treatments in the abdomen on a robotic radiosurgery system. Phys Imaging Radiat Oncol 2022; 23:103-108. [PMID: 35928600 PMCID: PMC9344339 DOI: 10.1016/j.phro.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Maaike T.W. Milder
- Corresponding author at: Department of Radiation Oncology, Erasmus MC – Cancer Institute, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
27
|
Magallon-Baro A, Milder MTW, Granton PV, den Toom W, Nuyttens JJ, Hoogeman MS. Impact of Using Unedited CT-Based DIR-Propagated Autocontours on Online ART for Pancreatic SBRT. Front Oncol 2022; 12:910792. [PMID: 35756687 PMCID: PMC9213731 DOI: 10.3389/fonc.2022.910792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the dosimetric impact of using unedited autocontours in daily plan adaptation of patients with locally advanced pancreatic cancer (LAPC) treated with stereotactic body radiotherapy using tumor tracking. Materials and Methods The study included 98 daily CT scans of 35 LAPC patients. All scans were manually contoured (MAN), and included the PTV and main organs-at-risk (OAR): stomach, duodenum and bowel. Precision and MIM deformable image registration (DIR) methods followed by contour propagation were used to generate autocontour sets on the daily CT scans. Autocontours remained unedited, and were compared to MAN on the whole organs and at 3, 1 and 0.5 cm from the PTV. Manual and autocontoured OAR were used to generate daily plans using the VOLO™ optimizer, and were compared to non-adapted plans. Resulting planned doses were compared based on PTV coverage and OAR dose-constraints. Results Overall, both algorithms reported a high agreement between unclipped MAN and autocontours, but showed worse results when being evaluated on the clipped structures at 1 cm and 0.5 cm from the PTV. Replanning with unedited autocontours resulted in better OAR sparing than non-adapted plans for 95% and 84% plans optimized using Precision and MIM autocontours, respectively, and obeyed OAR constraints in 64% and 56% of replans. Conclusion For the majority of fractions, manual correction of autocontours could be avoided or be limited to the region closest to the PTV. This practice could further reduce the overall timings of adaptive radiotherapy workflows for patients with LAPC.
Collapse
Affiliation(s)
- Alba Magallon-Baro
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maaike T W Milder
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Patrick V Granton
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wilhelm den Toom
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Joost J Nuyttens
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Mischa S Hoogeman
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| |
Collapse
|
28
|
Starace V, Cicinelli MV, Cavalleri M, Di Muzio N, Marchese A, Battista M, Bandello F, Miserocchi E, Modorati G. Ocular leukemic mass-like relapse treated with CyberKnife stereotactic radiosurgery. Acta Ophthalmol 2022; 100:e1036-e1038. [PMID: 34327856 DOI: 10.1111/aos.14986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/27/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Vincenzo Starace
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
| | - Michele Cavalleri
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Nadia Di Muzio
- Department of Radiotherapy IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Alessandro Marchese
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
| | - Marco Battista
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Francesco Bandello
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
| | - Elisabetta Miserocchi
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Giulio Modorati
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| |
Collapse
|
29
|
Chermat R, Ziaee M, Mak DY, Refet-Mollof E, Rodier F, Wong P, Carrier JF, Kamio Y, Gervais T. Radiotherapy on-chip: microfluidics for translational radiation oncology. LAB ON A CHIP 2022; 22:2065-2079. [PMID: 35477748 DOI: 10.1039/d2lc00177b] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The clinical importance of radiotherapy in the treatment of cancer patients justifies the development and use of research tools at the fundamental, pre-clinical, and ultimately clinical levels, to investigate their toxicities and synergies with systemic agents on relevant biological samples. Although microfluidics has prompted a paradigm shift in drug discovery in the past two decades, it appears to have yet to translate to radiotherapy research. However, the materials, dimensions, design versatility and multiplexing capabilities of microfluidic devices make them well-suited to a variety of studies involving radiation physics, radiobiology and radiotherapy. This review will present the state-of-the-art applications of microfluidics in these fields and specifically highlight the perspectives offered by radiotherapy on-a-chip in the field of translational radiobiology and precision medicine. This body of knowledge can serve both the microfluidics and radiotherapy communities by identifying potential collaboration avenues to improve patient care.
Collapse
Affiliation(s)
- Rodin Chermat
- μFO Lab, Polytechnique Montréal, Montréal, QC, Canada.
- Institut du Cancer de Montréal, (ICM), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Maryam Ziaee
- μFO Lab, Polytechnique Montréal, Montréal, QC, Canada.
- Institut du Cancer de Montréal, (ICM), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - David Y Mak
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Elena Refet-Mollof
- μFO Lab, Polytechnique Montréal, Montréal, QC, Canada.
- Institut du Cancer de Montréal, (ICM), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Francis Rodier
- Institut du Cancer de Montréal, (ICM), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de radiologie, radio-oncologie et médecine nucléaire, Université de Montréal, Montreal, QC, Canada
| | - Philip Wong
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Institut du Cancer de Montréal, (ICM), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Jean-François Carrier
- Département de radiologie, radio-oncologie et médecine nucléaire, Université de Montréal, Montreal, QC, Canada
- Département de Physique, Université de Montréal, Montréal, QC, Canada
- Département de Radio-oncologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Yuji Kamio
- Département de Radio-oncologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
- Département de Pharmacologie et Physiologie, Université de Montréal, Montreal, QC, Canada
| | - Thomas Gervais
- μFO Lab, Polytechnique Montréal, Montréal, QC, Canada.
- Institut du Cancer de Montréal, (ICM), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| |
Collapse
|
30
|
Casutt A, Kinj R, Ozsahin EM, von Garnier C, Lovis A. Fiducial markers for stereotactic lung radiation therapy: review of the transthoracic, endovascular and endobronchial approaches. Eur Respir Rev 2022; 31:31/163/210149. [PMID: 35022258 DOI: 10.1183/16000617.0149-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/09/2021] [Indexed: 11/05/2022] Open
Abstract
Stereotactic body radiation therapy is an alternative to surgery for early-stage, inoperable peripheral non-small cell lung cancer. As opposed to linear accelerator (linac)-based (e.g. gating) and free-breathing techniques, CyberKnife® with Synchrony® technology allows accurate radiation delivery by means of a real-time respiratory motion tracking system using, in most cases, metal fiducial markers (FMs) placed in the vicinity of the target. The aims of this review are as follows. First, to describe the safety and efficacy of the transthoracic, endovascular and endobronchial FM insertion techniques for peripheral pulmonary lesions (PPLs). Second, to analyse performance in terms of the migration and tracking rates of different FM types. Recent developments in FM tracking for central lesions will also be reviewed. In conclusion, for PPLs, the endobronchial approach provides a low rate of pneumothorax, offers the possibility of concurrent diagnostic sampling for both the PPL and the lymph nodes, and, finally, reduces the intervention time compared to other techniques. In this context, coil-tailed and coil-spring FMs have shown the lowest migration rate with a consequently high tracking rate.
Collapse
Affiliation(s)
- Alessio Casutt
- Division of Pulmonary Medicine, University Hospital of Lausanne, CHUV, Lausanne, Switzerland .,University of Lausanne, UNIL, Lausanne, Switzerland
| | - Rémy Kinj
- University of Lausanne, UNIL, Lausanne, Switzerland.,Dept of Radiation Oncology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Esat-Mahmut Ozsahin
- University of Lausanne, UNIL, Lausanne, Switzerland.,Dept of Radiation Oncology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Christophe von Garnier
- Division of Pulmonary Medicine, University Hospital of Lausanne, CHUV, Lausanne, Switzerland.,University of Lausanne, UNIL, Lausanne, Switzerland
| | - Alban Lovis
- Division of Pulmonary Medicine, University Hospital of Lausanne, CHUV, Lausanne, Switzerland.,University of Lausanne, UNIL, Lausanne, Switzerland
| |
Collapse
|
31
|
Takizawa T, Tanabe S, Nakano H, Utsunomiya S, Sakai M, Maruyama K, Takeuchi S, Nakano T, Ohta A, Kaidu M, Ishikawa H, Onda K. The impact of target positioning error and tumor size on radiobiological parameters in robotic stereotactic radiosurgery for metastatic brain tumors. Radiol Phys Technol 2022; 15:135-146. [DOI: 10.1007/s12194-022-00655-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 12/01/2022]
|
32
|
Deshpande SR, Grubb WR, Kharouta M, Zhang Y, Zheng Y, Podder TK, Towe C, Young B, Machtay M, Biswas T. A Comparative Study of Patients With Early-Stage Non-Small Cell Lung Cancer Treated With Stereotactic Body Radiation Therapy Using CyberKnife and Linear Accelerator-Based Volumetric Modulated Arc Therapy. Pract Radiat Oncol 2022; 12:200-209. [PMID: 35177369 DOI: 10.1016/j.prro.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/16/2021] [Accepted: 12/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) has become the standard of care for medically inoperable early-stage non-small cell lung cancer. We investigated 2 modalities of lung SBRT, CyberKnife (CK) and volumetric modulated arc therapy (VMAT), for differences in dosimetric parameters, tumor control, and clinical outcomes. METHODS AND MATERIALS Patients who underwent SBRT for T1-2N0M0 non-small cell lung cancer from 2012 to 2018 were included. Dosimetric parameters for target volume coverage and organ-at-risk dose distribution were collected. Survival outcomes were evaluated using the Kaplan-Meier method with log-rank test. A multivariate Cox proportional hazards model was analyzed for local, regional, and distant tumor control; overall survival (OS) and progression-free survival; and radiation pneumonitis. RESULTS Two hundred twenty-seven patients (142 CK, 85 VMAT SBRT) met inclusion criteria. Overall, the local, regional, and distant control rates were 89.3%, 86.3%, and 87.4% at 2 years, and the OS was 67.5% and 32.8% at 2 and 5 years, respectively. VMAT delivered higher maximum doses to the gross tumor volume and planning target volume and had a lower lung and heart V5. Although there was no difference in local or distant failure, progression-free survival, or OS, VMAT was associated with superior freedom from regional failure (adjusted hazard ratio, 0.26; P = .045). With no difference between treatment modalities, 11.9% of patients developed grade 1 to 2 radiation pneumonitis. There were no grade 3+ events of radiation pneumonitis. CONCLUSIONS This study revealed that VMAT and CK provided comparable local and distant control and survival outcomes; however, VMAT exhibited better regional control. Further study in this regard is imperative.
Collapse
Affiliation(s)
- Saarang R Deshpande
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - William R Grubb
- Department of Radiation Oncology, Augusta University, Augusta, Georgia
| | - Michael Kharouta
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio
| | - Yuxia Zhang
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio
| | - Yiran Zheng
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Tarun K Podder
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Christopher Towe
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Benjamin Young
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Mitchell Machtay
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Tithi Biswas
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio.
| |
Collapse
|
33
|
Saeidi H, Opfermann JD, Kam M, Wei S, Leonard S, Hsieh MH, Kang JU, Krieger A. Autonomous robotic laparoscopic surgery for intestinal anastomosis. Sci Robot 2022; 7:eabj2908. [PMID: 35080901 DOI: 10.1126/scirobotics.abj2908] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Autonomous robotic surgery has the potential to provide efficacy, safety, and consistency independent of individual surgeon's skill and experience. Autonomous anastomosis is a challenging soft-tissue surgery task because it requires intricate imaging, tissue tracking, and surgical planning techniques, as well as a precise execution via highly adaptable control strategies often in unstructured and deformable environments. In the laparoscopic setting, such surgeries are even more challenging because of the need for high maneuverability and repeatability under motion and vision constraints. Here we describe an enhanced autonomous strategy for laparoscopic soft tissue surgery and demonstrate robotic laparoscopic small bowel anastomosis in phantom and in vivo intestinal tissues. This enhanced autonomous strategy allows the operator to select among autonomously generated surgical plans and the robot executes a wide range of tasks independently. We then use our enhanced autonomous strategy to perform in vivo autonomous robotic laparoscopic surgery for intestinal anastomosis on porcine models over a 1-week survival period. We compared the anastomosis quality criteria-including needle placement corrections, suture spacing, suture bite size, completion time, lumen patency, and leak pressure-of the developed autonomous system, manual laparoscopic surgery, and robot-assisted surgery (RAS). Data from a phantom model indicate that our system outperforms expert surgeons' manual technique and RAS technique in terms of consistency and accuracy. This was also replicated in the in vivo model. These results demonstrate that surgical robots exhibiting high levels of autonomy have the potential to improve consistency, patient outcomes, and access to a standard surgical technique.
Collapse
Affiliation(s)
- H Saeidi
- Department of Computer Science, University of North Carolina Wilmington, Wilmington, NC 28403, USA.,Department of Mechanical Engineering, Johns Hopkins University; Baltimore, MD 21211, USA
| | - J D Opfermann
- Department of Mechanical Engineering, Johns Hopkins University; Baltimore, MD 21211, USA.,Laboratory for Computational Sensing and Robotics, Johns Hopkins University; Baltimore, MD 21211, USA
| | - M Kam
- Department of Mechanical Engineering, Johns Hopkins University; Baltimore, MD 21211, USA.,Laboratory for Computational Sensing and Robotics, Johns Hopkins University; Baltimore, MD 21211, USA
| | - S Wei
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University; Baltimore, MD 21211, USA.,Department of Electrical and Computer Engineering, Johns Hopkins University; Baltimore, MD 21211, USA
| | - S Leonard
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University; Baltimore, MD 21211, USA
| | - M H Hsieh
- Department of Urology, Children's National Hospital, 111 Michigan Ave. N.W., Washington, DC 20010, USA
| | - J U Kang
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University; Baltimore, MD 21211, USA.,Department of Electrical and Computer Engineering, Johns Hopkins University; Baltimore, MD 21211, USA
| | - A Krieger
- Department of Mechanical Engineering, Johns Hopkins University; Baltimore, MD 21211, USA.,Laboratory for Computational Sensing and Robotics, Johns Hopkins University; Baltimore, MD 21211, USA
| |
Collapse
|
34
|
Samadi Miandoab P, Saramad S, Setayeshi S. Target margin design through analyzing a large cohort of clinical log data in the cyberknife system. J Appl Clin Med Phys 2022; 23:e13476. [PMID: 35044071 PMCID: PMC8906228 DOI: 10.1002/acm2.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose Calculating the adequate target margin for real‐time tumor tracking using the Cyberknife system is a challenging issue since different sources of error exist. In this study, the clinical log data of the Cyberknife system were analyzed to adequately quantify the planned target volume (PTV) margins of tumors located in the lung and abdomen regions. Methods In this study, 45 patients treated with the Cyberknife module were examined. In this context, adequate PTV margins were estimated based on the Van Herk formulation and the uncertainty estimation method by considering the impact of errors and uncertainties. To investigate the impact of errors and uncertainties on the estimated PTV margins, a statistical analysis was also performed. Results Our study demonstrates five different sources of errors, including segmentation, deformation, correlation, prediction, and targeting errors, which were identified as the main sources of error in the Cyberknife system. Furthermore, the clinical evaluation of the current study reveals that the two different formalisms provided almost identical PTV margin estimates. Additionally, 4–5 mm and 5 mm margins on average could provide adequate PTV margins at lung and abdomen tumors in all three directions, respectively. Overall, it was found that concerning the PTV margins, the impact of correlation and prediction errors is very high, while the impact of robotics error is low. Conclusions The current study can address two limitations in previous researches, namely insufficient sample sites and a smaller number of patients. A comparison of the present results concerning the lung and abdomen areas with other studies reveals that the proposed strategy could provide a better reference in selection the PTV margins. To our knowledge, this study is one of the first attempts to estimate the PTV margins in the lung and abdomen regions for a large cohort of patients treated using the Cyberknife system.
Collapse
Affiliation(s)
- Payam Samadi Miandoab
- Department of Medical Radiation Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Shahyar Saramad
- Department of Medical Radiation Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Saeed Setayeshi
- Department of Medical Radiation Engineering, Amirkabir University of Technology, Tehran, Iran
| |
Collapse
|
35
|
The Role of Stereotactic Radiosurgery in the Management of Foramen Magnum Meningiomas-A Multicenter Analysis and Review of the Literature. Cancers (Basel) 2022; 14:cancers14020341. [PMID: 35053504 PMCID: PMC8773727 DOI: 10.3390/cancers14020341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Meningiomas represent the most common central nervous system (CNS) tumor. Despite their often benign nature, a tumor location in direct proximity to vital brain structures may lead to significant morbidity. This is the case for foramen magnum meningiomas (FMMs) as they grow at the skull base, next to the brain stem and foramen magnum. Surgical resection represents the mainstay of FMM treatments. In patients unsuitable for surgery, with tumor recurrences or tumor remnants after surgery, non-invasive treatment modalities may play a crucial role in patient management. Reports and studies on stereotactic radiosurgery (SRS) for the treatment of FMMs are scarce. This multicenter analysis reported the outcome data of 62 patients with FMMs. SRS achieved a high local tumor control and demonstrated a favorable safety profile. These results are in agreement with previous findings. SRS should be considered for selected FMM patients. Abstract Background: Foramen magnum meningiomas (FMMs) represent a considerable neurosurgical challenge given their location and potential morbidity. Stereotactic radiosurgery (SRS) is an established non-invasive treatment modality for various benign and malignant brain tumors. However, reports on single-session or multisession SRS for the management and treatment of FMMs are exceedingly rare. We report the largest FMM SRS series to date and describe our multicenter treatment experience utilizing robotic radiosurgery. Methods: Patients who underwent SRS between 2005 and 2020 as a treatment for a FMM at six different centers were eligible for analysis. Results: Sixty-two patients met the inclusion criteria. The median follow-up was 28.9 months. The median prescription dose and isodose line were 14 Gy and 70%, respectively. Single-session SRS accounted for 81% of treatments. The remaining patients received three to five fractions, with doses ranging from 19.5 to 25 Gy. Ten (16%) patients were treated for a tumor recurrence after surgery, and thirteen (21%) underwent adjuvant treatment. The remaining 39 FMMs (63%) received SRS as their primary treatment. For patients with an upfront surgical resection, histopathological examination revealed 22 World Health Organization grade I tumors and one grade II FMM. The median tumor volume was 2.6 cubic centimeters. No local failures were observed throughout the available follow-up, including patients with a follow-up ≥ five years (16 patients), leading to an overall local control of 100%. Tumor volume significantly decreased after treatment, with a median volume reduction of 21% at the last available follow-up (p < 0.01). The one-, three-, and five-year progression-free survival were 100%, 96.6%, and 93.0%, respectively. Most patients showed stable (47%) or improved (21%) neurological deficits at the last follow-up. No high-grade adverse events were observed. Conclusions: SRS is an effective and safe treatment modality for FMMs. Despite the paucity of available data and previous reports, SRS should be considered for selected patients, especially those with subtotal tumor resections, recurrences, and patients not suitable for surgery.
Collapse
|
36
|
Fisher C, Harty J, Yee A, Li CL, Komolibus K, Grygoryev K, Lu H, Burke R, Wilson BC, Andersson-Engels S. Perspective on the integration of optical sensing into orthopedic surgical devices. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:010601. [PMID: 34984863 PMCID: PMC8727454 DOI: 10.1117/1.jbo.27.1.010601] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
SIGNIFICANCE Orthopedic surgery currently comprises over 1.5 million cases annually in the United States alone and is growing rapidly with aging populations. Emerging optical sensing techniques promise fewer side effects with new, more effective approaches aimed at improving patient outcomes following orthopedic surgery. AIM The aim of this perspective paper is to outline potential applications where fiberoptic-based approaches can complement ongoing development of minimally invasive surgical procedures for use in orthopedic applications. APPROACH Several procedures involving orthopedic and spinal surgery, along with the clinical challenge associated with each, are considered. The current and potential applications of optical sensing within these procedures are discussed and future opportunities, challenges, and competing technologies are presented for each surgical application. RESULTS Strong research efforts involving sensor miniaturization and integration of optics into existing surgical devices, including K-wires and cranial perforators, provided the impetus for this perspective analysis. These advances have made it possible to envision a next-generation set of devices that can be rigorously evaluated in controlled clinical trials to become routine tools for orthopedic surgery. CONCLUSIONS Integration of optical devices into surgical drills and burrs to discern bone/tissue interfaces could be used to reduce complication rates across a spectrum of orthopedic surgery procedures or to aid less-experienced surgeons in complex techniques, such as laminoplasty or osteotomy. These developments present both opportunities and challenges for the biomedical optics community.
Collapse
Affiliation(s)
- Carl Fisher
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - James Harty
- Cork University Hospital and South Infirmary Victoria University Hospital, Department of Orthopaedic Surgery, Cork, Ireland
| | - Albert Yee
- University of Toronto, Sunnybrook Research Institute, Department of Surgery, Holland Bone and Joint Program, Division of Orthopaedic Surgery, Sunnybrook Health Sciences; Orthopaedic Biomechanics Laboratory, Physical Sciences Platform, Toronto, Canada
| | - Celina L. Li
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Katarzyna Komolibus
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Konstantin Grygoryev
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Huihui Lu
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Ray Burke
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Brian C. Wilson
- University of Toronto, Princess Margaret Cancer Centre/University Health Network, Department of Medical Biophysics, Toronto, Canada
| | - Stefan Andersson-Engels
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
- University College Cork, Department of Physics, Cork, Ireland
| |
Collapse
|
37
|
Soman C, Alghamdi SRM, Alazemi FNM, Alghamdi AAA. Cyberknife Radiosurgery for the Treatment of Head and Neck Cancer: A Systematic Review. Eur J Dent 2021; 16:266-273. [PMID: 34891184 PMCID: PMC9339918 DOI: 10.1055/s-0041-1736330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cyberknife radiosurgery is a frameless stereotactic robotic radiosurgery which has shown to deliver better treatment outcomes in the treatment of advanced head and neck (H&N) carcinomas, especially in previously irradiated and recurrent cases. The aim of the study was to perform a systematic review of the available data on the outcomes of Cyberknife radiosurgery for treatment of head and neck cancer and to evaluate its collective outcomes. This systematic review was registered with the university with the registration no. FRP/2019/63 and was approved by the Institutional Review Board (RC/IRB/2019/132). Literature search was performed in the following: PubMed, Science direct, SciELO, MyScienceWork, Microsoft Academ EMBASE, Directory of Open Access Journals, and Cochrane databases with the keywords “Cyberknife,” “oral cancer,” “oropharyngeal cancer,” and “head and neck cancer” and data was extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The records identified were 147 manuscripts. Excluded articles included 5 duplicate articles, 33 abstracts, 101 full text articles due to being off-topic, case reports, review, non-English, 1 survey, and 2 other articles containing data extracted from a main study which was already included. A total of 5 articles were evaluated for qualitative synthesis. The mean dose of Cyberknife radiosurgery delivered for previously irradiated recurrent H&N carcinoma patients was 34.57 Gy, with a mean sample size of 5 studied during the period of 2000 to 2016. The available evidence from the systematic review indicates that Cyberknife can be an efficacious treatment option for recurrent previously irradiated H&N carcinoma, especially for nonresectable tumors. There is paucity of homogenous data and studies in this arena; hence, meta-analysis could not be performed. Further standardized studies are essential, especially where the treatment of H&N carcinoma is considered.
Collapse
Affiliation(s)
- Cristalle Soman
- Department of Oral Medicine and Maxillofacial Radiology, Riyadh Elm University, Riyadh, Saudi Arabia
| | | | | | | |
Collapse
|
38
|
Li J, Zhang X, Pan Y, Zhuang H, Wang J, Yang R. Assessment of Delivery Quality Assurance for Stereotactic Radiosurgery With Cyberknife. Front Oncol 2021; 11:751922. [PMID: 34868957 PMCID: PMC8635503 DOI: 10.3389/fonc.2021.751922] [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: 08/02/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose The purpose of this study is to establish and assess a practical delivery quality assurance method for stereotactic radiosurgery with Cyberknife by analyzing the geometric and dosimetric accuracies obtained using a PTW31016 PinPoint ionization chamber and EBT3 films. Moreover, this study also explores the relationship between the parameters of plan complexity, target volume, and deliverability parameters and provides a valuable reference for improving plan optimization and validation. Methods One hundred fifty cases of delivery quality assurance plans were performed on Cyberknife to assess point dose and planar dose distribution, respectively, using a PTW31016 PinPoint ionization chamber and Gafchromic EBT3 films. The measured chamber doses were compared with the planned mean doses in the sensitive volume of the chamber, and the measured planar doses were compared with the calculated dose distribution using gamma index analysis. The gamma passing rates were evaluated using the criteria of 3%/1 mm and 2%/2 mm. The statistical significance of the correlations between the complexity metrics, target volume, and the gamma passing rate were analyzed using Spearman’s rank correlation coefficient. Results For point dose comparison, the averaged dose differences (± standard deviations) were 1.6 ± 0.73% for all the cases. For planar dose distribution, the mean gamma passing rate for 3%/1 mm, and 2%/2 mm evaluation criteria were 94.26% ± 1.89%, and 93.86% ± 2.16%, respectively. The gamma passing rates were higher than 90% for all the delivery quality assurance plans with the criteria of 3%/1 mm and 2%/2 mm. The difference in point dose was lowly correlated with volume of PTV, number of beams, and treatment time for 150 DQA plans, and highly correlated with volume of PTV for 18 DQA plans of small target. DQA gamma passing rate (2%/2 mm) was a moderate significant correlation for the number of nodes, number of beams and treatment time, and a low correlation with MU. Conclusion PTW31016 PinPoint ionization chamber and EBT3 film can be used for routine Cyberknife delivery quality assurance. The point dose difference should be within 3%. The gamma passing rate should be higher than 90% for the criteria of 3%/1 mm and 2%/2 mm. In addition, the plan complexity and PTV volume were found to have some influence on the plan deliverability.
Collapse
Affiliation(s)
- Jun Li
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Xile Zhang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Yuxi Pan
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Hongqing Zhuang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ruijie Yang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| |
Collapse
|
39
|
The role of stereotactic body radiation therapy and its integration with systemic therapies in metastatic kidney cancer: a multicenter study on behalf of the AIRO (Italian Association of Radiotherapy and Clinical Oncology) genitourinary study group. Clin Exp Metastasis 2021; 38:527-537. [PMID: 34748125 DOI: 10.1007/s10585-021-10131-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
Although systemic therapy represents the standard of care for polymetastatic kidney cancer, stereotactic body radiation therapy (SBRT) may play a relevant role in the oligometastatic setting. We conducted a multicenter study including oligometastatic kidney cancer treated with SBRT. We retrospectively analyzed 207 patients who underwent 245 SBRT treatments on 385 lesions, including 165 (42.9%) oligorecurrent (OR) and 220 (57.1%) oligoprogressive (OP) lesions. Most common sites were lung (30.9%) for OR group, and bone (32.7%) for OP group. Among 78 (31.8%) patients receiving concomitant systemic therapy, sunitinib (61.5%) and pazopanib (15.4%) were the most common for OR patients, while sunitinib (49.2%) and nivolumab (20.0%) for OP patients. End points were local control (LC), progression free survival (PFS), overall survival (OS), time to next systemic therapy (TTNS) and toxicity. Median follow-up was 18.6 months. 1, 2 and 3-year LC rates were 89.4%, 80.1% and 76.6% in OR patients, and 82.7%, 76.9% and 64.3% in those with OP, respectively. LC for OP group was influenced by clear cell histology (p = 0.000), total number of lesions (p = 0.004), systemic therapy during SBRT (p = 0.012), and SBRT dose (p = 0.012). Median PFS was 37.9 months. 1, 2- and 3-year OS was 92.7%, 86.4% and 81.8%, respectively. Median TTNS was 15.8 months for OR patients, and 13.9 months for OP patients. No grade 3 or higher toxicities were reported for both groups. SBRT may be considered an effective safe option in the multidisciplinary management of both OR and OP metastases from kidney cancer.
Collapse
|
40
|
An Improved Correlation Model for Respiration Tracking in Robotic Radiosurgery Using Essential Skin Surface Motion. IEEE Robot Autom Lett 2021. [DOI: 10.1109/lra.2021.3097250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
41
|
Zeverino M, Jia Y, Charosky L, Bourhis J, Bochud FO, Moeckli R. On the interplay effect for moving targets treated with the CyberKnife static tracking system. Phys Med 2021; 90:30-39. [PMID: 34530213 DOI: 10.1016/j.ejmp.2021.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To assess the interplay effect amplitude between different planned MU distributions and respiratory patterns in the CyberKnife system when treating moving targets with static tracking technique. METHODS Small- and Large-Respiratory Motions (SRM and LRM) differing in amplitude and frequency were simulated in a semi-anthropomorphic dynamic thorax phantom. The interplay effect was evaluated for both respiration motions in terms of GTV coverage and conformity for three plans designed with an increasing range of MU per beam (small, medium and large). Each plan was delivered three times changing the initial beam-on phase to assess the inter-fraction variation. Dose distributions were measured using radiochromic films placed in the GTV axial and sagittal planes. RESULTS Generally, SRM plans gave higher GTV coverage and were less dependent on beam-on phases than LRM plans. For SRM (LRM) plans, the GTV coverage ranged from 95.2% to 99.7% (85.9% to 99.8%). Maximum GTV coverage was found for large MU plans in SRM and for small MU plans in LRM. Minimum GTV coverage was found for medium MU plans for both SRM and LRM. For SRM plans, dose conformity decreased with increasing MU range while the variation was reduced for LRM plans. Large MU plans reduced the inter-fraction variation for SRM and LRM. CONCLUSIONS We confirmed the interplay effect between target motion and beam irradiation time for CyberKnife static tracking. Plans with large MU per beam improved the GTV coverage for small motion amplitude and the inter-fraction dose variation for large motion amplitude.
Collapse
Affiliation(s)
- Michele Zeverino
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Yihan Jia
- École polytechnique fédérale de Lausanne- EPFL, Lausanne, Switzerland
| | - Leo Charosky
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Jean Bourhis
- Radiation Oncology Department, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Francois O Bochud
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Raphael Moeckli
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
| |
Collapse
|
42
|
Manavalan M, Durai M, Narayanasamy G, Stathakis S, Godson HF, Subramani V. Output factor measurements with multiple detectors in CyberKnife ® Robotic Radiosurgery System. J Cancer Res Ther 2021; 17:870-874. [PMID: 34528534 DOI: 10.4103/jcrt.jcrt_962_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim The aim of this study was to measure and compare the output factor (OF) of a CyberKnife Robotic Radiosurgery System with eight different small field detectors and validate with Technical Report Series (TRS) report 483. Background Accurate dosimetry of CyberKnife system is limited due to the challenges in small field dosimetry. OF is a vital dosimetric parameter used in the photon beam modeling and any error would affect the dose calculation accuracy. Materials and Methods In this study, the OF was measured with eight different small-field detectors for the 12 IRIS collimators at 800 mm SAD setup at 15 mm depth. The detectors used were PTW 31016 PinPoint 3D, IBA PFD shielded diode, IBA EFD unshielded diode, IBA SFD unshielded diode (stereotactic), PTW 60008 shielded diode, PTW 60012 unshielded diode, PTW 60018 unshielded diode (stereotactic), and PTW 60019 CVD diamond detector. OF was obtained after correcting for field output correction factors from IAEA TRS No. 483. Results The field OFs in CyberKnife are derived from the measured data by applying the correction factors from Table 23 in TRS 483 for the eight small field detectors. These field OFs matched within 2% of peer-reviewed published values. The range and standard deviation showed a decreasing trend with collimator diameter. Conclusion The field OF obtained after applying the appropriate correction factor from TRS 483 matched well with the peer-reviewed published OFs. The inter-detector variation showed a decreasing trend with increasing collimator field size. This study gives physicists confidence in measuring field OFs while using small field detectors mentioned in this work.
Collapse
Affiliation(s)
| | - Manigandan Durai
- Department of Radiation Oncology, The Medicity, Gurugram, Haryana, India
| | - Ganesh Narayanasamy
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Henry Finlay Godson
- Research & Development Centre, Bharathiyar University, Coimbatore, Tamil Nadu, India
| | | |
Collapse
|
43
|
Yang B, Tang KK, Geng H, Lam WW, Wong YS, Huang CY, Chiu TL, Kong CW, Cheung CW, Cheung KY, Yu SK. Comparison of modeling accuracy between Radixact ®and CyberKnife ®Synchrony ®respiratory tracking system. Biomed Phys Eng Express 2021; 7. [PMID: 34416743 DOI: 10.1088/2057-1976/ac1fa5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/20/2021] [Indexed: 11/12/2022]
Abstract
Synchrony Respiratory Tracking system adapted from CyberKnife has been introduced in Radixact to compensate the tumor motion caused by respiration. This study aims to compare the modeling accuracy of the Synchrony system between Radixact and CyberKnife. Two Synchrony plans based on fiducial phantoms were created for CyberKnife and Radixact, respectively. Different respiratory motion traces were used to drive a motion platform to move along the superoinferior and left-right direction. The cycle time and the amplitude of target/surrogate motion of one selected motion trace were scaled to investigate the dependence of modeling accuracy on the motion characteristic. The predicted target position, the correlation error, potential difference (Radixact only) and standard error (CyberKnife only) were extracted from raw data or log files of the two systems. The modeling accuracy was evaluated by calculating the root-mean-square (RMS) error between the predicted target positions and the input motion trace. A threshold T95 within which 95% of the potential difference or the standard error lay was defined and evaluated. Except for the motion trace with a small amplitude and a good (linear) correlation between target and surrogate motion, Radixact showed smaller RMS errors than CyberKnife. The RMS error of both systems increased with the motion amplitude and showed a decreasing trend with the increasing cycle time. No correlation was found between the RMS error and the amplitude of surrogate motion. T95 could be a good estimator of modeling accuracy for CyberKnife rather than Radixact. The correlation error defined in Radixact were largely affected by the number of fiducial markers and the setup error. In general, the modeling accuracy of the Radixact Synchrony system is better than that of the CyberKnife Synchrony system under unfavorable conditions.
Collapse
Affiliation(s)
- B Yang
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong
| | - K K Tang
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong
| | - H Geng
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong
| | - W W Lam
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong
| | - Y S Wong
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong
| | - C Y Huang
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong
| | - T L Chiu
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong
| | - C W Kong
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong
| | - C W Cheung
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong
| | - K Y Cheung
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong
| | - S K Yu
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong
| |
Collapse
|
44
|
Magallon-Baro A, Milder MTW, Granton PV, Nuyttens JJ, Hoogeman MS. Comparison of Daily Online Plan Adaptation Strategies for a Cohort of Pancreatic Cancer Patients Treated with SBRT. Int J Radiat Oncol Biol Phys 2021; 111:208-219. [PMID: 33811976 DOI: 10.1016/j.ijrobp.2021.03.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/01/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To study the trade-offs of three online strategies to adapt treatment plans of patients with locally advanced pancreatic carcinoma (LAPC) treated using the CyberKnife with tumor tracking. METHODS AND MATERIALS A total of 35 planning computed tomography scans and 98 daily in-room computed tomography scans were collected from 35 patients with LAPC. Planned dose distributions, optimized with VOLO, were evaluated on manually contoured daily anatomies to collect daily doses. Three strategies were tested to adapt treatment plans: (1) unrestricted full replanning using a patient-specific plan template, (2) time-restricted replanning on organs at risk (OARs) within 3 cm from the planning target volume (PTV) structure, and (3) dose realignment optimization to stay within OAR constraints. Dose distributions resulting from each plan adaptation strategy were dosimetrically compared by means of gross tumor volume (GTV), PTV coverage, and OAR tolerances. RESULTS Planned doses did not result in dose-constraint violations for 28 of 98 daily anatomies. None of the suggested plan adaptation strategies improved planned doses significantly for this subset. For 70 of the 98 reported violations, the median (interquartile range) PTV coverage of the planned dose was 84% (76% to 86%). After plan adaptation, unrestricted replanning achieved clinically acceptable plans in 93% of these fractions, time-restricted replanning in 90%, and dose realignment in 74%, at median computational times of 8.5, 3, and 0.5 minutes. Over all 98 fractions, PTV coverage was reduced: -1% (-3% to 1%), -2% (-5% to 0%), and -2% (-8% to 0%) after each strategy, respectively. In 3 of 70 fractions, none of the suggested strategies achieved clinically acceptable OAR dose volumes. CONCLUSIONS Unrestricted replanning was the most time-consuming method but reached the highest number of successfully adapted plans. Time-restricted replanning and dose realignment resulted in a high number of plans within dose constraints. Depending on the resources available, an adaptive strategy can be selected for each patient to address the specific anatomic challenges on the treatment day. The increase in the complexity of the strategy corresponds with an increasing number of successfully adapted plans.
Collapse
Affiliation(s)
- Alba Magallon-Baro
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
| | - Maaike T W Milder
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Patrick V Granton
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Joost J Nuyttens
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Mischa S Hoogeman
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
45
|
Sallabanda M, Garcia R, Lorenzana L, Santaolalla I, Abarca J, Sallabanda K. Treatment of Chordomas and Chondrosarcomas With CyberKnife Robotic Hypofractionated Radiosurgery: A Single Institution Experience. Cureus 2021; 13:e17012. [PMID: 34405079 PMCID: PMC8352833 DOI: 10.7759/cureus.17012] [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] [Accepted: 08/06/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The aim of this study is to determine the efficacy and safety of CyberKnife® (Accuray, Inc., Sunnyvale, CA) hypofractionated radiosurgery (HfRS) in the treatment of chordomas and chondrosarcomas. Methods A total of 24 patients retrospectively identified with chordomas (19 patients) or chondrosarcomas (five patients) were treated between 2012 and 2019 with HfRS as monotherapy or an adjuvant, rescue, or combination therapy. Tumors were located in the skull base (75%) and vertebral spine (25%). Of these, 19 patients underwent previous partial resection and four patients received previous conventional external beam radiation therapy (EBRT) (60-74 Gy). Exclusive or rescue HfRS (20 patients) was administered in five fractions with a median dose of 37.5 Gy (30-40 Gy). Combined tomotherapy-EBRT treatment (median dose: 54 Gy) and HfRS (16.5-30 Gy in 3-12 fractions) were performed in four patients with bulky chordomas. Results The median follow-up from HfRS was 28 months. During clinical follow-up, no deaths were registered with overall survival (OS) of 100% and the actuarial local recurrence-free survival (LRFS) was 93% at one year, 85% at three years, and 68% at five years. Acute toxicity related to HfRS was present in a single patient. Conclusions It is seen that HfRS is effective and safe for chordomas and chondrosarcomas, with rates of LRFS comparable to other radiation modalities.
Collapse
Affiliation(s)
| | - Rafael Garcia
- Radiation Oncology, Genesis Care Cyberknife Center, Madrid, ESP
| | - Luis Lorenzana
- Neurosurgery, Genesis Care Cyberknife Center, Madrid, ESP
| | | | - Javier Abarca
- Neurological Surgery, Hospital General de Alicante, Madrid, ESP
| | - Kita Sallabanda
- Radiosurgery/Neurosurgery, Hospital Clinico Universitario San Carlos, Madrid, ESP
| |
Collapse
|
46
|
De Martin E, Alhujaili S, Fumagalli ML, Ghielmetti F, Marchetti M, Gallo P, Aquino D, Padelli F, Davis J, Alnaghy S, Carrara M, Fariselli L, Rosenfeld AB, Petasecca M. On the evaluation of edgeless diode detectors for patient-specific QA in high-dose stereotactic radiosurgery. Phys Med 2021; 89:20-28. [PMID: 34343763 DOI: 10.1016/j.ejmp.2021.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE In this work, the potential of an innovative "edgeless" silicon diode was evaluated as a response to the still unmet need of a reliable tool for plan dosimetry verification of very high dose, non-coplanar, patient-specific radiosurgery treatments. In order to prove the effectiveness of the proposed technology, we focused on radiosurgical treatments for functional disease like tremor or pain. METHODS The edgeless diodes response has been validated with respect to clinical practice standard detectors by reproducing the reference dosimetry data adopted for the Treatment Planning System. In order to evaluate the potential for radiosurgery patient-specific treatment plan verification, the anthropomorphic phantom Alderson RANDO has been adopted along with three edgeless sensors, one placed in the centre of the Planning Target Volume, one superiorly and one inferiorly. RESULTS The reference dosimetry data obtained from the edgeless detectors are within 2.6% for output factor, off-axis ratio and well within 2% for tissue phantom ratio when compared to PTW 60,018 diode. The edgeless detectors measure a dose discrepancy of approximately 3.6% from the mean value calculated by the TPS. Larger discrepancies are obtained in very steep gradient dose regions when the sensors are placed outside the PTV. CONCLUSIONS The angular independent edgeless diode is proposed as an innovative dosimeter for patient quality assurance of brain functional disorders and other radiosurgery treatments. The comparison of the diode measurements with TPS calculations confirms that edgeless diodes are suitable candidates for patient-specific dosimetric verification in very high dose ranges delivered by non-isocentric stereotactic radiosurgery modalities.
Collapse
Affiliation(s)
- Elena De Martin
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Health Department, Via Giovanni Celoria 11, 20133 Milan, Italy.
| | - Sultan Alhujaili
- Centre for Medical Radiation Physics, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia; Medical Imaging Department, College of Applied Medical Sciences, Aljouf University, Aljouf 72388, Saudi Arabia.
| | - Maria Luisa Fumagalli
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Health Department, Via Giovanni Celoria 11, 20133 Milan, Italy.
| | - Francesco Ghielmetti
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Health Department, Via Giovanni Celoria 11, 20133 Milan, Italy.
| | - Marcello Marchetti
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Radiotherapy Unit, Department of Neurosurgery, Via Giovanni Celoria 11, 20133 Milan, Italy.
| | - Pasqualina Gallo
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Health Department, Via Giovanni Celoria 11, 20133 Milan, Italy.
| | - Domenico Aquino
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroradiology Unit, Via Giovanni Celoria 11, 20133 Milan, Italy.
| | - Francesco Padelli
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroradiology Unit, Via Giovanni Celoria 11, 20133 Milan, Italy.
| | - Jeremy Davis
- Centre for Medical Radiation Physics, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
| | - Saree Alnaghy
- Centre for Medical Radiation Physics, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
| | - Mauro Carrara
- Fondazione IRCCS Istituto Nazionale Dei Tumori, s.s.d. di Fisica Medica, Dipartimento di Diagnostica per Immagini e Radioterapia, Via Giacomo Venezian 1, 20133 Milan, Italy.
| | - Laura Fariselli
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Radiotherapy Unit, Department of Neurosurgery, Via Giovanni Celoria 11, 20133 Milan, Italy.
| | - Anatoly B Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
| | - Marco Petasecca
- Centre for Medical Radiation Physics, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia
| |
Collapse
|
47
|
Taillez A, Bimbai AM, Lacornerie T, Le Deley MC, Lartigau EF, Pasquier D. Studies of Intra-Fraction Prostate Motion During Stereotactic Irradiation in First Irradiation and Re-Irradiation. Front Oncol 2021; 11:690422. [PMID: 34336678 PMCID: PMC8316636 DOI: 10.3389/fonc.2021.690422] [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: 04/02/2021] [Accepted: 06/28/2021] [Indexed: 12/01/2022] Open
Abstract
Background Understanding intra-fractional prostate motions is crucial for stereotactic body radiation therapy (SBRT). No studies have focused on the intra-fractional prostate motions during re-irradiation with SBRT. The objective was to evaluate these translational and rotational motions in primary treated patients and in the context of re-irradiation. Methods From January 2011 to March 2020, 162 patients with histologically proven prostate cancer underwent prostate SBRT, including 58 as part of a re-irradiation treatment. We used the continuous coordinates of the fiducial markers collected by an orthogonal X-ray dual-image monitoring system. The translations and rotations of the prostate were calculated. Prostate deviations representing overall movement was defined as the length of the 3D-vectors. Results A total of 858 data files were analyzed. The deviations over time in the group of primary treated patients were significantly larger than that of the group of re-irradiation, leading to a mean deviation of 2.73 mm (SD =1.00) versus 1.90 mm (SD =0.79), P<0.001. In the re-irradiation group, we identified displacements of -0.05 mm (SD =1.53), 0.20 mm (SD =1.46); and 0.42 mm (SD =1.24) in the left-right, superior-inferior and anterior-posterior planes. Overall, we observed increasing deviations over the first 30 min followed by a stabilization related to movements in the three translational axes. Conclusion This is the first study to focus on intrafraction prostate motions in the context of re-irradiation. We observed that intra-fraction prostate motions persisted in the setting of re-irradiation, although they showed a significant reduction when compared with the first irradiation. These results will help to better estimate random errors during SBRT treatment of intra-prostatic recurrence after irradiation.
Collapse
Affiliation(s)
- Alexandre Taillez
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, Lille, France.,University of Lille, Lille, France
| | - Andre-Michel Bimbai
- Department of Biostatistics, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Thomas Lacornerie
- Department of Medical Physics, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Marie-Cecile Le Deley
- Department of Biostatistics, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Eric F Lartigau
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, Lille, France.,University of Lille, Lille, France.,CRISTAL UMR CNRS 9189, University of Lille, Lille, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, Lille, France.,University of Lille, Lille, France.,CRISTAL UMR CNRS 9189, University of Lille, Lille, France
| |
Collapse
|
48
|
68Ga-DOTATOC-PET/MRI-A Secure One-Stop Shop Imaging Tool for Robotic Radiosurgery Treatment Planning in Patients with Optic Nerve Sheath Meningioma. Cancers (Basel) 2021; 13:cancers13133305. [PMID: 34282752 PMCID: PMC8267930 DOI: 10.3390/cancers13133305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023] Open
Abstract
Optic nerve sheath meningiomas (ONSM) are rare but can lead to irreversible blindness. Hybrid imaging may enhance tumor delineation and diagnostic accuracy via receptor binding. However, relevant clinical data for ONSM are lacking. We evaluated the feasibility of receptor-based hybrid imaging prior to robotic radiosurgery (RRS). We retrospectively analyzed all of our institution's patients with suspected ONSM who underwent combined positron emission tomography and magnetic resonance imaging (PET/MRI) with gallium-68-labeled (DOTA0-Phe1-Tyr3) octreotide (Ga68-DOTATOC) before RRS between 2018 and 2019. Eight patients with ten suspected ONSM (female = 7; median age, 51.2 years; IQR, 43.0-66.0) were included. Nine out of ten ONSM were deemed PET-positive with a median standard uptake value (SUV) max of 5.6 (IQR, 2.6-7.8). For all nine ONSM that presented 68Ga-DOTATOC uptake, hybrid PET/MRI was used for target volume contouring prior to RSS. At a median follow-up of 11.7 months (IQR, 9.4-16.4), tumor control was achieved in all patients. Radiosurgery resulted in the improvement of visual acuity in two of eight patients, whereas six showed stable vision. Ga68-DOTATOC-PET/MRI can be used for target volume contouring prior to RRS for ONSM as it enables safe treatment planning and improves diagnostic accuracy.
Collapse
|
49
|
Rahimi A, Morgan HE, Kim DW, Zhang Y, Leitch M, Wooldridge R, Goudreau S, Haley B, Rao R, Rivers A, Spangler AE, Jones RT, Stevenson S, Staley J, Albuquerque K, Ahn C, Neufeld S, Alluri PG, Ding C, Garwood D, Seiler S, Zhao B, Gu X, Timmerman R. Cosmetic Outcomes of a Phase 1 Dose Escalation Study of 5-Fraction Stereotactic Partial Breast Irradiation for Early Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2021; 110:772-782. [PMID: 33476737 DOI: 10.1016/j.ijrobp.2021.01.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Our purpose was to evaluate cosmetic changes after 5-fraction adjuvant stereotactic partial breast irradiation (S-PBI). METHODS AND MATERIALS Seventy-five women with in situ or invasive breast cancer stage 0, I, or II, with tumor size ≤3 cm, were enrolled after lumpectomy in a phase 1 dose escalation trial of S-PBI into cohorts receiving 30, 32.5, 35, 37.5, or 40 Gy in 5 fractions. Before S-PBI, 3 to 4 gold fiducial markers were placed in the lumpectomy cavity for tracking with the Synchrony respiratory tracking system. S-PBI was delivered with a CyberKnife robotic radiosurgery system. Patients and physicians evaluated global cosmesis using the Harvard Breast Cosmesis Scale. Eight independent panelists evaluated digital photography for global cosmesis and 10 subdomains at baseline and follow-up. McNemar tests were used to evaluate change in cosmesis, graded as excellent/good or fair/poor, from baseline to year 3. Wilcoxon signed rank tests were used to evaluate change in subdomains. Cohen's kappa (κ) statistic was used to estimate interobserver agreement (IOA) between raters, and Fleiss' κ was used to estimate IOA between panelists. RESULTS Median cosmetic follow-up was 5, 5, 5, 4, and 3 years for the 30, 32.5, 35, 37.5, and 40 Gy cohorts. Most patients reported excellent/good cosmesis at both baseline (86.3%) and year 3 (89.8%). No dose cohort had significantly worsened cosmesis by year 3 on McNemar analysis. No cosmetic subdomain had significant worsening by year 3. IOA was fair for patient-physician (κ = 0.300, P < .001), patient-panel (κ = 0.295, P < .001), physician-panel (κ = 0.256, P < .001), and individual panelists (Fleiss κ = 0.327, P < .001). CONCLUSIONS Dose escalation of S-PBI from 30 to 40 Gy in 5 fractions for early stage breast cancer was not associated with a detectable change in cosmesis by year 3. S-PBI is a promising modality for treatment of early stage breast cancer.
Collapse
Affiliation(s)
- Asal Rahimi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Howard E Morgan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dong W Kim
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yuanyuan Zhang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Marilyn Leitch
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rachel Wooldridge
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sally Goudreau
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Barbara Haley
- Department of Medicine, Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Roshni Rao
- Department of Surgery, Columbia University, New York, New York
| | - Aeisha Rivers
- Department of Surgery, Memorial Health Care System, Pembroke Pines, Florida
| | - Ann E Spangler
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ryan T Jones
- Department of Radiation Oncology, Tennessee Oncology, Nashville, Tennessee
| | - Stella Stevenson
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jason Staley
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chul Ahn
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sarah Neufeld
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Prasanna G Alluri
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chuxiong Ding
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dan Garwood
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stephen Seiler
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bo Zhao
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, Uniondale, New York
| | - Xuejun Gu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
50
|
DI Franco R, Borzillo V, Alberti D, Ametrano G, Petito A, Coppolaro A, Tarantino I, Rossetti S, Pignata S, Iovane G, Perdonà S, Quarto G, Grimaldi G, Izzo A, Castaldo L, Muscariello R, Serra M, Facchini G, Muto P. Acute Toxicity in Hypofractionated/Stereotactic Prostate Radiotherapy of Elderly Patients: Use of the Image-guided Radio Therapy (IGRT) Clarity System. In Vivo 2021; 35:1849-1856. [PMID: 33910872 DOI: 10.21873/invivo.12447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The use of intra-fractional monitoring and correction of prostate position with the Image Guided Radio Therapy (IGRT) system can increase the spatial accuracy of dose delivery. Clarity is a system used for intrafraction prostate-motion management, it provides a real-time visualization of prostate with a transperineal ultrasound. The aim of this study was to evaluate the use of Clarity-IGRT on proper intrafraction alignment and monitoring, its impact on Planning Tumor Volume margin and on urinary and rectal toxicity in elderly patients not eligible for surgery. PATIENTS AND METHODS Twenty-five elderly prostate cancer patients, median age=75 years (range=75-90 years) were treated with Volumetric Radiotherapy and Clarity-IGRT using 3 different schemes: A) 64.5/72 Gray (Gy) in 30 fractions on prostate and seminal vesicles (6 patients); B) 35 Gy in 5 fractions on prostate and seminal vesicles (12 patients); C): 35 Gy in 5 fractions on prostate (7 patients). Ultrasound identification of the overlapped structures to the detected ones during simulation has been used in each session. A specific software calculates direction and entity of necessary shift to obtain the perfect match. The average misalignment in the three-dimensional space has been determined and shown in a box-plot. RESULTS All patients completed treatment with mild-moderate toxicity. During treatment, genitourinary toxicity was 32% Grade 1; 4% Grade 2, rectal was 4% Grade 1. At follow-up of 3 months, genitourinary toxicity was 20% Grade 1; 4% Grade 2, rectal toxicity was 4% Grade 2. At follow-up of 6 months, genitourinary toxicity was 4% Grade 1; 4% Grade 2. Rectal toxicity was 4% Grade 2. CONCLUSION Radiotherapy with the Clarity System allows a reduction of PTV margins, the amount of fractions can be reduced increasing the total dose, not exacerbating urinary and rectal toxicity with greater patient's compliance.
Collapse
Affiliation(s)
- Rossella DI Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy;
| | - Valentina Borzillo
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Domingo Alberti
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Gianluca Ametrano
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Angela Petito
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Andrea Coppolaro
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Ilaria Tarantino
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sabrina Rossetti
- Departmental Unit Of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sandro Pignata
- Departmental Unit Of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Gelsomina Iovane
- Departmental Unit Of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sisto Perdonà
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Giuseppe Quarto
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Giovanni Grimaldi
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Alessandro Izzo
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Luigi Castaldo
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Raffaele Muscariello
- Uro-Gynecological Department, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Marcello Serra
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Gaetano Facchini
- Department of Hospital Medicine, Unit of Medical Oncology, ASL Napoli 2 Nord, "S.M. delle Grazie" Hospital, Pozzuoli, Italy
| | - Paolo Muto
- Department of Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| |
Collapse
|