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Qin A, Chen S, Liang J, Snyder M, Yan D. Evaluation of DIR schemes on tumor/organ with progressive shrinkage: accuracy of tumor/organ internal tissue tracking during the radiation treatment. Radiother Oncol 2022; 173:170-178. [PMID: 35667570 DOI: 10.1016/j.radonc.2022.05.039] [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: 12/13/2021] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Accuracy of intratumoral treatment dose accumulation and response assessment highly depends on the accuracy of a DIR method. However, achievable accuracy of the existing DIR methods for tumor/organ with large and progressive shrinkage during the radiotherapy course have not been explored. This study aimed to use a bio-tissue phantom to quantify the achievable accuracy of different DIR schemes. MATERIALS /METHODS A fresh porcine liver was used for phantom material. Sixty gold markers were implanted on the surface and inside of the liver. To simulate the progressive radiation-induced tumor/organ shrinkage, the phantom was heated using a microwave oven incrementally from 30s to 200s in 8 phases. For each phase, the phantom was scanned by CT. Two extra image sets were generated from the original images: 1) the image set with overriding the high-density gold markers (feature image); 2) the image set with overriding the entire phantom to the mean soft tissue intensity (featureless image). Ten DIR schemes were evaluated to mimic clinical treatment situations of tumor/critical organ with respect to their surface and internal condition of image features, availability of intermediate feedback images and DIR methods. The internal marker's positions were utilized to evaluate DIR accuracy quantified by target registration error (TRE). RESULTS Volume reduction was about 20% ∼ 40% of the initial volume after 90s ∼ 200s of the heating. Without image features on the surface and inside of the phantom, the hybrid-DIR (image-based DIR followed by biomechanical model-based refinement) with the surface constraint achieved the registration TRE from 2.6 ± 1.2mm to 5.3 ± 2.6mm proportional to the %volume shrinkage. Meanwhile, the hybrid-DIR with the surface-marker constraint achieved the TRE from 2.4 ± 1.2mm to 2.6 ± 1.0mm. If both the surface and internal image features would be viable on the feedback images, the achievable accuracy could be minimal with the TRE from 1.6±0.9mm to 1.9 ± 1.2mm. CONCLUSIONS Standard DIR methods cannot guarantee intratumoral tissue registration accuracy for tumor/organ with large progressive shrinkage. Achievable accuracy with using the hybrid DIR method is highly dependent on the surface registration accuracy. If the surface registration mean TRE can be controlled within 2mm, the mean TRE of internal tissue can be controlled within 3mm.
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Affiliation(s)
- An Qin
- Dept. of Radiation Oncology, Beaumont Health System, Royal Oak, United States
| | - Shupeng Chen
- Dept. of Radiation Oncology, Beaumont Health System, Royal Oak, United States
| | - Jian Liang
- Dept. of Radiation Oncology, Beaumont Health System, Royal Oak, United States
| | - Michael Snyder
- Dept. of Radiation Oncology, Beaumont Health System, Royal Oak, United States
| | - Di Yan
- Dept. of Radiation Oncology, Beaumont Health System, Royal Oak, United States; Radiation Oncology, Huaxi Hospitals & Medical School, Chengdu, China.
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Kadman B, Takemura A, Ito T, Okada N, Kojima H, Ueda S. Accuracy of patient setup positioning using surface‐guided radiotherapy with deformable registration in cases of surface deformation. J Appl Clin Med Phys 2022; 23:e13493. [PMID: 35077004 PMCID: PMC9398221 DOI: 10.1002/acm2.13493] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
The Catalyst™ HD (C‐RAD Positioning AB, Uppsala, Sweden) is surface‐guided radiotherapy (SGRT) equipment that adopts a deformable model. The challenge in applying the SGRT system is accurately correcting the setup error using a deformable model when the body of the patient is deformed. This study evaluated the effect of breast deformation on the accuracy of the setup correction of the SGRT system. Physical breast phantoms were used to investigate the relationship between the mean deviation setup error obtained from the SGRT system and the breast deformation. Physical breast phantoms were used to simulate extension and shrinkage deformation (−30 to 30 mm) by changing breast pieces. Three‐dimensional (3D) Slicer software was used to evaluate the deformation. The maximum deformations in X, Y, and Z directions were obtained as the differences between the original and deformed breasts. We collected the mean deviation setup error from the SGRT system by replacing the original breast part with the deformed breast part. The mean absolute difference of lateral, longitudinal, vertical, pitch, roll, and yaw, between the rigid and deformable registrations was 2.4 ± 1.7 mm, 1.3 ± 1.2 mm, 6.4 ± 5.2 mm, 2.5° ± 2.5°, 2.2° ± 2.4°, and 1.0° ± 1.0°, respectively. Deformation in the Y direction had the best correlation with the mean deviation translation error (R = 0.949) and rotation error (R = 0.832). As the magnitude of breast deformation increased, both mean deviation setup errors increased, and there was greater error in translation than in rotation. Large deformation of the breast surface affects the setup correction. Deformation in the Y direction most affects translation and rotation errors.
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Affiliation(s)
- Boriphat Kadman
- Division of Health Sciences Graduate School of Medical Sciences, Pharmaceutical and Health Sciences Kanazawa University 5‐11‐80 Kodatsuno Kanazawa Ishikawa 9200942 Japan
| | - Akihiro Takemura
- Faculty of Health Sciences Institute of Medical, Pharmaceutical and Health Sciences Kanazawa University 5‐11‐80 Kodatsuno Kanazawa Ishikawa 9200942 Japan
| | - Tatsuya Ito
- Department of Radiological Technology Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital 2‐9 Myouke‐cho, Showa‐ku Nagoya Aichi 4668650 Japan
| | - Naoki Okada
- Division of Health Sciences Graduate School of Medical Sciences, Pharmaceutical and Health Sciences Kanazawa University 5‐11‐80 Kodatsuno Kanazawa Ishikawa 9200942 Japan
| | - Hironori Kojima
- Department of Radiology Kanazawa University Hospital 13‐1 Takara‐machi Kanazawa Ishikawa 9208641 Japan
| | - Shinichi Ueda
- Department of Radiology Kanazawa University Hospital 13‐1 Takara‐machi Kanazawa Ishikawa 9208641 Japan
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Shi L, Chen Q, Barley S, Cui Y, Shang L, Qiu J, Rong Y. Benchmarking of Deformable Image Registration for Multiple Anatomic Sites Using Digital Data Sets With Ground-Truth Deformation Vector Fields. Pract Radiat Oncol 2021; 11:404-414. [PMID: 33722783 DOI: 10.1016/j.prro.2021.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/27/2021] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to evaluate the accuracy of deformable image registration (DIR) algorithms using data sets with different levels of ground-truth deformation vector fields (DVFs) and to investigate the correlation between DVF errors and contour-based metrics. METHODS AND MATERIALS Nine pairs of digital data sets were generated through contour-controlled deformations based on 3 anonymized patients' CTs (head and neck, thorax/abdomen, and pelvis) with low, medium, and high deformation intensity for each site using the ImSimQA software. Image pairs and their associated contours were imported to MIM-Maestro, Raystation, and Velocity systems, followed by DIR and contour propagation. The system-generated DVF and propagated contours were compared with the ground-truth data. The correlation between DVF errors and contour-based metrics was evaluated using the Pearson correlation coefficient (r), while their correlation with volumes were calculated using Spearman correlation coefficient (rho). RESULTS The DVF errors increased with increasing deformation intensity. All DIR algorithms performed well for esophagus, trachea, left femoral, right femoral, and urethral (mean and maximum DVF errors <2.50 mm and <4.27 mm, respectively; Dice similarity coefficient: 0.93-0.99). Brain, liver, left lung, and bladder showed large DVF errors for all 3 systems (dmax: 2.8-91.90 mm). The minimum and maximum DVF errors, conformity index, and Dice similarity coefficient were correlated with volumes (|rho|: 0.41-0.64), especially for very large or small structures (|rho|: 0.64-0.80). Only mean distance to agreement of Raystation and Velocity correlated with some indices of DVF errors (r: 0.70-0.78). CONCLUSIONS Most contour-based metrics had no correlation with DVF errors. For adaptive radiation therapy, well-performed contour propagation does not directly indicate accurate dose deformation and summation/accumulation within each contour (determined by DVF accuracy). Tolerance values for DVF errors should vary as the acceptable accuracy for overall adaptive radiation therapy depends on anatomic site, deformation intensity, organ size, and so forth. This study provides benchmark tables for evaluating DIR accuracy in various clinical scenarios.
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Affiliation(s)
- Liting Shi
- Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, California; School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Science, Suzhou, Jiangsu, China
| | - Quan Chen
- Department of Radiation Oncology, University of Kentucky, Lexington, Kentucky
| | - Susan Barley
- Oncology Systems Limited (OSL), Shrewsbury, Shropshire, United Kingdom
| | - Yunfeng Cui
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Lu Shang
- Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, California
| | - Jianfeng Qiu
- Medical Engineering and Technology Research Center; Imaging-X Joint Laboratory; Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, China
| | - Yi Rong
- Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, California; Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona.
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Glide-Hurst CK, Lee P, Yock AD, Olsen JR, Cao M, Siddiqui F, Parker W, Doemer A, Rong Y, Kishan AU, Benedict SH, Li XA, Erickson BA, Sohn JW, Xiao Y, Wuthrick E. Adaptive Radiation Therapy (ART) Strategies and Technical Considerations: A State of the ART Review From NRG Oncology. Int J Radiat Oncol Biol Phys 2020; 109:1054-1075. [PMID: 33470210 DOI: 10.1016/j.ijrobp.2020.10.021] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 12/21/2022]
Abstract
The integration of adaptive radiation therapy (ART), or modifying the treatment plan during the treatment course, is becoming more widely available in clinical practice. ART offers strong potential for minimizing treatment-related toxicity while escalating or de-escalating target doses based on the dose to organs at risk. Yet, ART workflows add complexity into the radiation therapy planning and delivery process that may introduce additional uncertainties. This work sought to review presently available ART workflows and technological considerations such as image quality, deformable image registration, and dose accumulation. Quality assurance considerations for ART components and minimum recommendations are described. Personnel and workflow efficiency recommendations are provided, as is a summary of currently available clinical evidence supporting the implementation of ART. Finally, to guide future clinical trial protocols, an example ART physician directive and a physics template following standard NRG Oncology protocol is provided.
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Affiliation(s)
- Carri K Glide-Hurst
- Department of Human Oncology, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Percy Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam D Yock
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey R Olsen
- Department of Radiation Oncology, University of Colorado- Denver, Denver, Colorado
| | - Minsong Cao
- Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, California
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - William Parker
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Anthony Doemer
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Yi Rong
- Department of Radiation Oncology, University of California-Davis, Sacramento, California
| | - Amar U Kishan
- Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, California
| | - Stanley H Benedict
- Department of Radiation Oncology, University of California-Davis, Sacramento, California
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Beth A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jason W Sohn
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Evan Wuthrick
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
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Swamidas J, Kirisits C, De Brabandere M, Hellebust TP, Siebert FA, Tanderup K. Image registration, contour propagation and dose accumulation of external beam and brachytherapy in gynecological radiotherapy. Radiother Oncol 2020; 143:1-11. [DOI: 10.1016/j.radonc.2019.08.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023]
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Head and Neck Cancer Adaptive Radiation Therapy (ART): Conceptual Considerations for the Informed Clinician. Semin Radiat Oncol 2019; 29:258-273. [PMID: 31027643 DOI: 10.1016/j.semradonc.2019.02.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
For nearly 2 decades, adaptive radiation therapy (ART) has been proposed as a method to account for changes in head and neck tumor and normal tissue to enhance therapeutic ratios. While technical advances in imaging, planning and delivery have allowed greater capacity for ART delivery, and a series of dosimetric explorations have consistently shown capacity for improvement, there remains a paucity of clinical trials demonstrating the utility of ART. Furthermore, while ad hoc implementation of head and neck ART is reported, systematic full-scale head and neck ART remains an as yet unreached reality. To some degree, this lack of scalability may be related to not only the complexity of ART, but also variability in the nomenclature and descriptions of what is encompassed by ART. Consequently, we present an overview of the history, current status, and recommendations for the future of ART, with an eye toward improving the clarity and description of head and neck ART for interested clinicians, noting practical considerations for implementation of an ART program or clinical trial. Process level considerations for ART are noted, reminding the reader that, paraphrasing the writer Elbert Hubbard, "Art is not a thing, it is a way."
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