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Salari E, Wang J, Wynne JF, Chang CW, Wu Y, Yang X. Artificial intelligence-based motion tracking in cancer radiotherapy: A review. J Appl Clin Med Phys 2024:e14500. [PMID: 39194360 DOI: 10.1002/acm2.14500] [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: 09/15/2023] [Revised: 07/13/2024] [Accepted: 07/27/2024] [Indexed: 08/29/2024] Open
Abstract
Radiotherapy aims to deliver a prescribed dose to the tumor while sparing neighboring organs at risk (OARs). Increasingly complex treatment techniques such as volumetric modulated arc therapy (VMAT), stereotactic radiosurgery (SRS), stereotactic body radiotherapy (SBRT), and proton therapy have been developed to deliver doses more precisely to the target. While such technologies have improved dose delivery, the implementation of intra-fraction motion management to verify tumor position at the time of treatment has become increasingly relevant. Artificial intelligence (AI) has recently demonstrated great potential for real-time tracking of tumors during treatment. However, AI-based motion management faces several challenges, including bias in training data, poor transparency, difficult data collection, complex workflows and quality assurance, and limited sample sizes. This review presents the AI algorithms used for chest, abdomen, and pelvic tumor motion management/tracking for radiotherapy and provides a literature summary on the topic. We will also discuss the limitations of these AI-based studies and propose potential improvements.
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Affiliation(s)
- Elahheh Salari
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Jing Wang
- Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob Frank Wynne
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Chih-Wei Chang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Yizhou Wu
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
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Byrne M, Teh AYM, Archibald-Heeren B, Hu Y, Rijken J, Luo S, Aland T, Greer P. Intrafraction Motion and Margin Assessment for Ethos Online Adaptive Radiotherapy Treatments of the Prostate and Seminal Vesicles. Adv Radiat Oncol 2024; 9:101405. [PMID: 38304111 PMCID: PMC10831186 DOI: 10.1016/j.adro.2023.101405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/27/2023] [Indexed: 02/03/2024] Open
Abstract
Purpose Online adaptive radiation therapy (OART) uses daily imaging to identify changes in the patient's anatomy and generate a new treatment plan adapted to these changes for each fraction. The aim of this study was to determine the intrafraction motion and planning target volume (PTV) margins required for an OART workflow on the Varian Ethos system. Methods and Materials Sixty-five fractions from 13 previously treated OART patients were analyzed for this retrospective study. The prostate and seminal vesicles were contoured by a radiation oncologist on 2 cone beam computed tomography scans (CBCT) for each fraction, the initial CBCT at the start of the treatment session, and the verification CBCT immediately before beam-on. In part 1 of the study, PTVs of different sizes were defined on the initial CBCT, and the geometric overlap with the clinical target volume (CTV) on the verification CBCT was used to determine the optimal OART margin. This was performed with and without a patient realignment shift by registering the verification CBCT to the initial CBCT. In part 2 of the study, the margins determined in part 1 were used for simulated Ethos OART treatments on all 65 fractions. The resultant coverage to the CTV on the verification CBCT, was compared with an image guided radiation therapy (IGRT) workflow with 7-mm margins. Results Part 1 of the study found, if a verification CBCT and shift is performed, a 4-mm margin on the prostate and 5 mm on the seminal vesicles resulted in 95% of the CTV covered by the PTV in >90% of fractions, and 98% of the CTV covered by the PTV in >80% of fractions. Part 2 of the study found when these margins were used in an Ethos OART workflow, they resulted in CTV coverage that was superior to an IGRT workflow with 7-mm margins. Conclusions A 4mm prostate margin and 5-mm seminal vesicles margin in an OART workflow with verification imaging are adequate to ensure coverage on the Varian Ethos system. Larger margins may be required if using an OART workflow without verification imaging.
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Affiliation(s)
- Mikel Byrne
- Icon Cancer Centre, South Brisbane, Queensland, Australia
- School of Information and Physical Sciences, University of Newcastle, Newcastle, New South Wales, Australia
- Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
| | - Amy Yuen Meei Teh
- Icon Cancer Centre, South Brisbane, Queensland, Australia
- Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
- ANU College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Yunfei Hu
- Icon Cancer Centre, South Brisbane, Queensland, Australia
| | - James Rijken
- Icon Cancer Centre, South Brisbane, Queensland, Australia
| | - Suhuai Luo
- School of Information and Physical Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Trent Aland
- Icon Cancer Centre, South Brisbane, Queensland, Australia
| | - Peter Greer
- School of Information and Physical Sciences, University of Newcastle, Newcastle, New South Wales, Australia
- Calvary Mater Newcastle Hospital, Newcastle, New South Wales, Australia
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Bleeker M, Hulshof MCCM, Bel A, Sonke JJ, van der Horst A. Stomach Motion and Deformation: Implications for Preoperative Gastric Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 118:543-553. [PMID: 37633498 DOI: 10.1016/j.ijrobp.2023.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Selection and development of image guided strategies for preoperative gastric radiation therapy requires quantitative knowledge of the various sources of anatomic changes of the stomach. This study aims to investigate the magnitude of interfractional and intrafractional stomach motion and deformation using fiducial markers and 4-dimensional (4D) imaging. METHODS AND MATERIALS Fourteen patients who underwent preoperative gastric cancer radiation therapy received 2 to 6 fiducial markers distributed throughout the stomach (total of 54 markers) and additional imaging (ie, 1 planning 4D computed tomography [pCT], 20-25 pretreatment 4D cone beam [CB] CTs, 4-5 posttreatment 4D CBCTs). Marker coordinates on all end-exhale (EE) and end-inhale (EI) scans were obtained after a bony anatomy match. Interfractional marker displacements (ie, between EE pCT and all EE CBCTs) were evaluated for 5 anatomic regions (ie, cardia, small curvature, proximal and distal large curvature, and pylorus). Motion was defined as displacement of the center-of-mass of available markers (COMstomach), deformation as the average difference in marker-pair distances. Interfractional (ie, between EE pCT and all EE CBCTs), respiratory (between EE and EI pCT and CBCTs), and pre-post (pre- and posttreatment EE CBCTs) motion and deformation were quantified. RESULTS The interfractional marker displacement varied per anatomic region and direction, with systematic and random errors ranging from 1.6-8.8 mm and 2.2-8.2 mm, respectively. Respiratory motion varied per patient (median, 3-dimensional [3D] amplitude 5.2-20.0 mm) and day (interquartile range, 0.8-4.2 mm). Regarding COMstomach motion, respiratory motion was larger than interfractional motion (median, 10.9 vs 8.9 mm; P < .0001; Wilcoxon rank-sum), which was larger than pre-post motion (3.6 mm; P < .0001). Interfractional deformations (median, 5.8 mm) were significantly larger than pre-post deformations (2.6 mm; P < .0001), which were larger than respiratory deformation (1.8 mm; P < .0001). CONCLUSIONS The demonstrated sizable stomach motions and deformations during radiation therapy stress the need for generous nonuniform planning target volume margins for preoperative gastric cancer radiation therapy. These margins can be decreased by daily image guidance and adaptive radiation therapy.
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Affiliation(s)
- Margot Bleeker
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Astrid van der Horst
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Zhao Y, Haworth A, Rowshanfarzad P, Ebert MA. Focal Boost in Prostate Cancer Radiotherapy: A Review of Planning Studies and Clinical Trials. Cancers (Basel) 2023; 15:4888. [PMID: 37835581 PMCID: PMC10572027 DOI: 10.3390/cancers15194888] [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: 08/17/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Focal boost radiotherapy was developed to deliver elevated doses to functional sub-volumes within a target. Such a technique was hypothesized to improve treatment outcomes without increasing toxicity in prostate cancer treatment. PURPOSE To summarize and evaluate the efficacy and variability of focal boost radiotherapy by reviewing focal boost planning studies and clinical trials that have been published in the last ten years. METHODS Published reports of focal boost radiotherapy, that specifically incorporate dose escalation to intra-prostatic lesions (IPLs), were reviewed and summarized. Correlations between acute/late ≥G2 genitourinary (GU) or gastrointestinal (GI) toxicity and clinical factors were determined by a meta-analysis. RESULTS By reviewing and summarizing 34 planning studies and 35 trials, a significant dose escalation to the GTV and thus higher tumor control of focal boost radiotherapy were reported consistently by all reviewed studies. Reviewed trials reported a not significant difference in toxicity between focal boost and conventional radiotherapy. Acute ≥G2 GU and late ≥G2 GI toxicities were reported the most and least prevalent, respectively, and a negative correlation was found between the rate of toxicity and proportion of low-risk or intermediate-risk patients in the cohort. CONCLUSION Focal boost prostate cancer radiotherapy has the potential to be a new standard of care.
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Affiliation(s)
- Yutong Zhao
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA 6009, Australia; (P.R.); (M.A.E.)
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, The University of Sydney, Camperdown, NSW 2050, Australia;
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA 6009, Australia; (P.R.); (M.A.E.)
- Centre for Advanced Technologies in Cancer Research (CATCR), Perth, WA 6000, Australia
| | - Martin A. Ebert
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA 6009, Australia; (P.R.); (M.A.E.)
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
- 5D Clinics, Claremont, WA 6010, Australia
- School of Medicine and Population Health, University of Wisconsin, Madison WI 53706, USA
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Sawayanagi S, Yamashita H, Ogita M, Takenaka R, Nozawa Y, Watanabe Y, Imae T, Abe O. Injection of hydrogel spacer increased maximal intrafractional prostate motion in anterior and superior directions during volumetric modulated arc therapy-stereotactic body radiation therapy for prostate cancer. Radiat Oncol 2022; 17:41. [PMID: 35197092 PMCID: PMC8867734 DOI: 10.1186/s13014-022-02008-3] [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: 03/31/2021] [Accepted: 02/13/2022] [Indexed: 12/03/2022] Open
Abstract
Background The aim of this study was to clarify the association between intrafractional prostate shift and hydrogel spacer. Methods Thirty-eight patients who received definitive volumetric modulated arc therapy (VMAT)-stereotactic body radiation therapy (SBRT) for prostate cancer with prostate motion monitoring in our institution in 2018–2019 were retrospectively evaluated. In order to move the rectum away from the prostate, hydrogel spacer (SpaceOAR system, Boston Scientific, Marlborough, the United States) injection was proposed to the patients as an option in case of meeting the indication of use. We monitored intrafractional prostate motion by using a 4-dimensional (4D) transperineal ultrasound device: the Clarity 4D ultrasound system (Elekta AB). The deviation of the prostate was monitored in each direction: superior-inferior, left–right, and anterior–posterior. We also calculated the vector length. The maximum intrafractional displacement (MID) per fraction for each direction was detected and mean of MIDs was calculated per patient. The MIDs in the non-spacer group and the spacer group were compared using the unpaired t-test. Results We reviewed 33 fractions in eight patients as the spacer group and 148 fractions in 30 patients as the non-spacer group. The superior MID was 0.47 ± 0.07 (mean ± SE) mm versus 0.97 ± 0.24 mm (P = 0.014), the inferior MID was 1.07 ± 0.11 mm versus 1.03 ± 0.25 mm (P = 0.88), the left MID was 0.74 ± 0.08 mm versus 0.87 ± 0.27 mm (P = 0.55), the right MID was 0.67 ± 0.08 mm versus 0.92 ± 0.21 mm (P = 0.17), the anterior MID was 0.45 ± 0.06 mm versus 1.16 ± 0.35 mm (P = 0.0023), and the posterior MID was 1.57 ± 0.17 mm versus 1.37 ± 0.22 mm (P = 0.56) in the non-spacer group and the spacer group, respectively. The max of VL was 2.24 ± 0.19 mm versus 2.89 ± 0.62 mm (P = 0.19), respectively. Conclusions Our findings suggest that maximum intrafractional prostate motion during VMAT-SBRT was larger in patients with hydrogel spacer injection in the superior and anterior directions. Since this difference seemed not to disturb the dosimetric advantage of the hydrogel spacer, we do not recommend routine avoidance of the hydrogel spacer use.
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Affiliation(s)
- Subaru Sawayanagi
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Mami Ogita
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryosuke Takenaka
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuki Nozawa
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuichi Watanabe
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshikazu Imae
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Ipsen S, Wulff D, Kuhlemann I, Schweikard A, Ernst F. Towards automated ultrasound imaging-robotic image acquisition in liver and prostate for long-term motion monitoring. Phys Med Biol 2021; 66. [PMID: 33770768 DOI: 10.1088/1361-6560/abf277] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/26/2021] [Indexed: 11/12/2022]
Abstract
Real-time volumetric (4D) ultrasound has shown high potential for diagnostic and therapy guidance tasks. One of the main drawbacks of ultrasound imaging to date is the reliance on manual probe positioning and the resulting user dependence. Robotic assistance could help overcome this issue and facilitate the acquisition of long-term image data to observe dynamic processesin vivoover time. The aim of this study is to assess the feasibility of robotic probe manipulation and organ motion quantification during extended imaging sessions. The system consists of a collaborative robot and a 4D ultrasound system providing real-time data access. Five healthy volunteers received liver and prostate scans during free breathing over 30 min. Initial probe placement was performed with real-time remote control with a predefined contact force of 10 N. During scan acquisition, the probe position was continuously adjusted to the body surface motion using impedance control. Ultrasound volumes, the pose of the end-effector and the estimated contact forces were recorded. For motion analysis, one anatomical landmark was manually annotated in a subset of ultrasound frames for each experiment. Probe contact was uninterrupted over the entire scan duration in all ten sessions. Organ drift and imaging artefacts were successfully compensated using remote control. The median contact force along the probe's longitudinal axis was 10.0 N with maximum values of 13.2 and 21.3 N for liver and prostate, respectively. Forces exceeding 11 N only occurred in 0.3% of the time. Probe and landmark motion were more pronounced in the liver, with median interquartile ranges of 1.5 and 9.6 mm, compared to 0.6 and 2.7 mm in the prostate. The results show that robotic ultrasound imaging with dynamic force control can be used for stable, long-term imaging of anatomical regions affected by motion. The system facilitates the acquisition of 4D image datain vivoover extended scanning periods for the first time and holds the potential to be used for motion monitoring for therapy guidance as well as diagnostic tasks.
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Affiliation(s)
- Svenja Ipsen
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany.,Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering IMTE, Luebeck, Germany
| | - Daniel Wulff
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - Ivo Kuhlemann
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - Achim Schweikard
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - Floris Ernst
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
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Lee JJB, Lee IJ, Choi Y, Jeon MJ, Jung IH, Lee H. Clinical Implications of Geometric and Dosimetric Uncertainties of Inter- and Intra-Fractional Movement during Volumetric Modulated Arc Therapy for Breast Cancer Patients. Cancers (Basel) 2021; 13:cancers13071651. [PMID: 33916047 PMCID: PMC8036414 DOI: 10.3390/cancers13071651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/19/2021] [Accepted: 03/27/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Radiotherapy is an essential treatment modality for breast cancer. Compared to conventional radiotherapy techniques, modern radiotherapy with fewer fractions and smaller target volumes requires higher accuracy. Image-guidance using cone-beam computed tomography (CBCT) is one of the most common methods used for positional verification before treatment. This study reports geometric and dosimetric outcomes evaluated by analyzing CBCT images acquired before and during treatments. The positional change and internal movement of the patient were less than 1 cm in most cases without significant deviation in the dosimetric parameters of interest. However, there were cases involving extreme variation, which resulted in insufficient radiation delivered to the target areas and increased radiation exposure to adjacent normal organs. The results of the current study suggest that unexpected intra-fractional motion may occur, prompting for marginal adaptation in selected patients who are deemed to suffer from this kind of event. Abstract With the introduction of modern sophisticated radiotherapy (RT) techniques, the significance of accuracy has increased considerably. This study evaluated the necessity of pre-treatment and intra-fractional cone-beam computed tomography (CBCT) by analyzing inter- and intra-fractional CBCT images of breast cancer patients receiving RT. From 57 patients, 1206 pre-treatment CBCT and 1067 intra-fractional CBCT images were collected. Geometric movements of patients were measured quantitively in both inter- and intra-fractional CBCT, and changes in dosimetric parameters were evaluated in selected patients with extreme intra-fractional movement. For right-sided breast cancer patients, left-sided breast cancer patients treated using deep-inspiration breath hold (DIBH), and left-sided breast cancer patients treated using continuous positive airway pressure (CPAP), median inter-fractional deviations were 0.53 (range 0.06–2.98) cm, 0.66 (range 0.08–4.41) cm, and 0.69 (range 0.04–3.80) cm, and median intra-fractional deviations were 0.14 (range 0.00–0.62) cm, 0.23 (range 0.02–0.96) cm, and 0.24 (0.00–1.15) cm, respectively. Modified plans reflecting large changes in intra-fractional position in 10 selected cases revealed insufficient target coverage in seven cases and more than 20-fold increase in the volume of heart receiving at least 25 Gy in two cases. Intra-fractional verification, as well as pre-treatment verification, might be considered in patients using DIBH or CPAP.
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Affiliation(s)
- Jason Joon Bock Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (J.J.B.L.); (I.J.L.); (Y.C.); (M.J.J.); (I.H.J.)
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (J.J.B.L.); (I.J.L.); (Y.C.); (M.J.J.); (I.H.J.)
| | - Yeonho Choi
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (J.J.B.L.); (I.J.L.); (Y.C.); (M.J.J.); (I.H.J.)
| | - Mi Jin Jeon
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (J.J.B.L.); (I.J.L.); (Y.C.); (M.J.J.); (I.H.J.)
| | - Il Hun Jung
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (J.J.B.L.); (I.J.L.); (Y.C.); (M.J.J.); (I.H.J.)
| | - Ho Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (J.J.B.L.); (I.J.L.); (Y.C.); (M.J.J.); (I.H.J.)
- Correspondence: ; Tel.: +82-2-2019-3153; Fax: +82-2-2019-4855
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Optimizing planning CT using past CT images for prostate cancer volumetric modulated arc therapy. Med Dosim 2020; 45:213-218. [PMID: 32008885 DOI: 10.1016/j.meddos.2019.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/30/2019] [Accepted: 12/11/2019] [Indexed: 11/20/2022]
Abstract
This study aimed to evaluate a new method to optimize planning computed tomography (CT) using three-dimensional (3D) displacement error between the planning and diagnosed past CT scans. Thirty-two patients undergoing volumetric modulated arc therapy for prostate cancer were evaluated for a 3D displacement error between bone- and prostate-matching spatial coordinates using multiple acquisition planning CT (MPCT) scans. Each MPCT image and a past CT image were used to perform rigid image registration (RIR) and deformable image registration (DIR), and the 3D displacement error was calculated. Correlations of the 3D displacement error in each MPCT scan and between the MPCT and past CT were evaluated based on RIR and DIR, respectively. The 3D displacement error in the MPCT images exhibited moderate correlation with the 3D displacement error between MPCT and past CT for both RIR (adjusted r2 = 0.495) and DIR (adjusted r2 = 0.398). In the correlation analysis between MPCT and past CT, image pairs with 3D displacement errors ≥ 6 mm were significantly different from those with errors < 6 mm (p < 0.0001). Past CT images were different from the planning CT images, which can be attributed to setup tools, flat-top plates, and physical differences due to the presence or absence of urine as well as prescription effects. The relationship between bone and prostate exhibited small deviations between the planning and past CT regardless of pretreatment. The prostate, which only has a slight effect on the displacement between it and bladder volume, was covered with a stiff pelvic bone. As a result, MPCT images exhibited correlations with past CT images of various difference states such as body positions. Finally, large 3D displacement errors in prostate position were caused by pelvic tension and stress, which can be detected using diagnosed past CT images instead of requiring MPCT scans. By comparing past and planning CT images, the random displacement error in the planning CT scan can be avoided by evaluating 3D displacement errors. The new method using the past CT images can estimate the displacement error of the prostate during the treatment period with 1 plan CT scan only, and it helps improve the treatment accuracy.
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Ma X, Yan H, Nath R, Chen Z, Li H, Liu W. Adaptive Imaging Versus Periodic Surveillance for Intrafraction Motion Management During Prostate Cancer Radiotherapy. Technol Cancer Res Treat 2019; 18:1533033819844489. [PMID: 31177934 PMCID: PMC6558533 DOI: 10.1177/1533033819844489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To evaluate the benefits of adaptive imaging with automatic correction compared to
periodic surveillance strategies with either manual or automatic correction. Methods: Using Calypso trajectories from 54 patients with prostate cancer at 2 institutions, we
simulated 5-field intensity-modulated radiation therapy and dual-arc
volumetric-modulated arc therapy with periodic imaging at various frequencies and with
continuous adaptive imaging, respectively. With manual/automatic correction, we assumed
there was a 30/1 second delay after imaging to determine and apply couch shift. For
adaptive imaging, real-time “dose-free” cine-MV images during beam delivery are used in
conjunction with online-updated motion pattern information to estimate 3D displacement.
Simultaneous MV-kV imaging is only used to confirm the estimated overthreshold motion
and calculate couch shift, hence very low additional patient dose from kV imaging. Results: Without intrafraction intervention, the prostates could on average have moved out of a
3-mm margin for ∼20% of the beam-on time after setup imaging in current clinical
situation. If the time interval from the setup imaging to beam-on can be reduced to only
30 seconds, the mean over-3 mm percentage can be reduced to ∼7%. For intensity-modulated
radiation therapy simulation, with manual correction, 110 and 70 seconds imaging periods
both reduced the mean over-3 mm time to ∼4%. Automatic correction could give another 1%
to 2% improvement. However, with either manual or automatic correction, the maximum
patient-specific over-3 mm time was still relatively high (from 6.4% to 12.6%) and those
patients are actually clinically most important. In contrast, adaptive imaging with
automatic intervention significantly reduced the mean percentage to 0.6% and the maximum
to 2.7% and averagely only ∼1 kV image and ∼1 couch shift were needed per fraction. The
results of volumetric-modulated arc therapy simulation show a similar trend to that of
intensity-modulated radiation therapy. Conclusions: Adaptive continuous monitoring with automatic motion compensation is more beneficial
than periodic imaging surveillance at similar or even less imaging dose.
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Affiliation(s)
- Xiangyu Ma
- 1 School of Biomedical Engineering, Capital Medical University, Beijing, China.,2 Department of Therapeutic Radiology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA.,3 Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Huagang Yan
- 1 School of Biomedical Engineering, Capital Medical University, Beijing, China.,2 Department of Therapeutic Radiology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA
| | - Ravinder Nath
- 2 Department of Therapeutic Radiology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA
| | - Zhe Chen
- 2 Department of Therapeutic Radiology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA
| | - Haiyun Li
- 1 School of Biomedical Engineering, Capital Medical University, Beijing, China.,3 Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Wu Liu
- 2 Department of Therapeutic Radiology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA
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10
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Tanabe Y, Ishida T. Optimizing multiple acquisition planning CT for prostate cancer IMRT. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab0dc7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ghaffari H, Navaser M, Mofid B, Mahdavi SR, Mohammadi R, Tavakol A. Fiducial markers in prostate cancer image-guided radiotherapy. Med J Islam Repub Iran 2019; 33:15. [PMID: 31086794 PMCID: PMC6504932 DOI: 10.34171/mjiri.33.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Image-guided radiotherapy (IGRT) is recommended to reduce the risk of geometrical miss when modern radiotherapy technologies with high grades of conformity are used. The purpose of this study was to evaluate the efficacy of fiducial markers (FMs) for electronic portal imaging in prostate cancer radiotherapy in term of evaluating the complications associated with FMs implantation, quantifying inter-fraction prostate motion, and determination of optimal planning target volume (PTV) margins.
Methods: In this single institution, prospective, consecutive study, 27 patients underwent implantation of three-gold seed FMs into the prostate gland before prostate radiotherapy. Prior to computed tomography planning, all patients were asked to report any complication associated with FMs implantation that have experienced to date. Daily pre-treatment electronic portal images were captured, and prostate position errors were corrected if they were greater than 2 mm along three translational directions. Optimal PTV expansions were computed using van Herk formula [PTV-margin= 2.5Σ + 0.7σ].
Results: FMs implantation was successful with an acceptable toxicity profile in all patients. Without IGRT, margins of 5.4 mm, 5.8 mm and 5.5 mm, in vertical, longitudinal and lateral directions, respectively, are needed for a 95% confidence level of complete clinical target volume (CTV) coverage in each treatment session. The PTV margins of 3.0 mm, 3.3 mm and 4.0 mm in corresponding directions were calculated when FMs based electronic portal imaging was applied.
Conclusion: FMs based electronic portal imaging is an effective tool for prostate cancer IGRT.
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Affiliation(s)
- Hamed Ghaffari
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Navaser
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mofid
- Department of Radiation Oncology, Shohada-e-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seied Rabi Mahdavi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Mohammadi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Asieh Tavakol
- Department of Medical Physics, Roshana Radiotherapy Cancer Center, Tehran, Iran
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Tamihardja J, Zenk M, Flentje M. MRI-guided localization of the dominant intraprostatic lesion and dose analysis of volumetric modulated arc therapy planning for prostate cancer. Strahlenther Onkol 2018; 195:145-152. [PMID: 30209535 DOI: 10.1007/s00066-018-1364-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/23/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE Primary radiation therapy is a curative treatment option for prostate cancer. The aim of this study was to evaluate the detection of the dominant intraprostatic lesion (DIL) with magnetic resonance imaging (MRI) for radiotherapy treatment planning, the comparison with transrectal ultrasound (TRUS)-guided biopsies and the examination of the dose distribution in relation to the DIL location. MATERIALS AND METHODS In all, 54 patients with treatment planning MRI for primary radiotherapy of prostate cancer from 03/2015 to 03/2017 at the Universitätsklinikum Würzburg were identified. The localization of the DIL was based on MRI with T2- and diffusion-weighted imaging. After registration of the MR image sets within Pinnacle3 (Philips Radiation Oncology Systems, Fitchburg, WI, USA), the dose distribution was analyzed. The location of the DIL was compared to the pathology reports in a side-based manner. RESULTS The DIL mean dose (Dmean) was 77.51 ± 0.77 Gy and in 50/51 cases within the tolerance range or exceeded the prescribed dose. There was a significant difference in Dmean between ventral (n = 21) and dorsal (n = 30) DIL (77.87 ± 0.67 vs. 77.26 ± 0.77 Gy; p = 0.005). MRI-guided localization showed an accuracy and sensitivity of up to 78.8% and 82.1% for inclusion of secondary lesions, respectively. CONCLUSION Up to 82.1% of histologically verified intraprostatic lesions were identified in the context of MRI-guided radiotherapy treatment planning. As expected, dorsal DIL tend to be minimally underdosed in comparison to ventral DIL. Adequate dose coverage was achieved in over 98% of patients.
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Affiliation(s)
- Jörg Tamihardja
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.
| | - Maria Zenk
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Michael Flentje
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
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Determination of Intrafraction Prostate Motion During External Beam Radiation Therapy With a Transperineal 4-Dimensional Ultrasound Real-Time Tracking System. Int J Radiat Oncol Biol Phys 2018; 101:136-143. [DOI: 10.1016/j.ijrobp.2018.01.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/08/2017] [Accepted: 01/10/2018] [Indexed: 11/21/2022]
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Bhattacharjee A, Jose J, Vishwakarma GK, Kumar R. Joint modeling of missing and mismeasured measurements for computing radiotherapy margins. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2017. [DOI: 10.1016/j.cegh.2016.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Sheng Y, Li T, Lee WR, Yin FF, Wu QJ. Exploring the Margin Recipe for Online Adaptive Radiation Therapy for Intermediate-Risk Prostate Cancer: An Intrafractional Seminal Vesicles Motion Analysis. Int J Radiat Oncol Biol Phys 2017; 98:473-480. [DOI: 10.1016/j.ijrobp.2017.02.089] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/27/2017] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
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Impact of the use of an endorectal balloon on rectal dosimetry during stereotactic body radiation therapy for localized prostate cancer. Pract Radiat Oncol 2016; 6:262-267. [DOI: 10.1016/j.prro.2015.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/10/2015] [Accepted: 10/28/2015] [Indexed: 11/19/2022]
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Shademan A, Decker RS, Opfermann J, Leonard S, Kim PCW, Krieger A. Plenoptic Cameras in Surgical Robotics: Calibration, Registration, and Evaluation. IEEE INTERNATIONAL CONFERENCE ON ROBOTICS AND AUTOMATION : ICRA : [PROCEEDINGS]. IEEE INTERNATIONAL CONFERENCE ON ROBOTICS AND AUTOMATION 2016; 2016:708-714. [PMID: 33614192 DOI: 10.1109/icra.2016.7487197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Three-dimensional sensing of changing surgical scenes would improve the function of surgical robots. This paper explores the requirements and utility of a new type of depth sensor, the plenoptic camera, for surgical robots. We present a metric calibration procedure for the plenoptic camera and the registration of its coordinate frame to the robot (hand-eye calibration). We also demonstrate the utility in robotic needle insertion and application of sutures in phantoms. The metric calibration accuracy is reported as 1.14 ± 0.80 mm for the plenoptic camera and 1.57 ± 0.90 mm for hand-eye calibration. The accuracy of needle insertion task is 1.79 ± 0.35 mm for the entire robotic system. Additionally, the accuracy of suture placement with the presented system is reported at 1.80 ± 0.43 mm. Finally, we report consistent suture spacing with only 0.11 mm standard deviation between inter-suture distances. The measured accuracy of less than 2 mm with consistent suture spacing is a promising result to provide repeatable leak-free suturing with a robotic tool and a plenoptic depth imager.
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Affiliation(s)
- Azad Shademan
- School of Automation, Southeast University, Nanjing, Jiangsu, China; Kanazawa University, Kanazawa, Japan
| | - Ryan S Decker
- Control Science and Engineering Department, University of Shanghai for Science and Technology, Shanghai, China; Kanazawa University, Kanazawa, Japan
| | - Justin Opfermann
- School of Automation, Southeast University, Nanjing, Jiangsu, China; Kanazawa University, Kanazawa, Japan
| | | | | | - Axel Krieger
- Industrial Research Institute of Ishikawa, Kanazawa, Japan
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Grimm M, Wenz F. [Localized prostate cancer: Radiotherapeutic concepts]. Urologe A 2016; 55:326-32. [PMID: 26895435 DOI: 10.1007/s00120-016-0042-4] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Radiation therapy is an established cornerstone in the treatment of prostate cancer. Significant advances in the techniques and therapeutic concepts have been made in recent decades. OBJECTIVES The objective of this article is to provide an overview of current standards of care and recent technical and conceptional developments. CONCLUSIONS Three-dimensional conformal radiotherapy has long been the standard of care for percutaneous radiotherapy. The development of intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT) have increased the precision of treatment, thus, reducing side effects and allowing dose escalation. LDR (low dose rate) and HDR (high dose rate) brachytherapy alone or in combination are a treatment option in localized prostate cancer with a distinct side effect profile. The roles of proton therapy and stereotactic radiotherapy should be further investigated in prospective trials.
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Affiliation(s)
- M Grimm
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Deutschland.
| | - F Wenz
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Deutschland
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Ouyang L, Lee HP, Wang J. A moving blocker-based strategy for simultaneous megavoltage and kilovoltage scatter correction in cone-beam computed tomography image acquired during volumetric modulated arc therapy. Radiother Oncol 2015; 115:425-30. [PMID: 26026484 DOI: 10.1016/j.radonc.2015.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 03/26/2015] [Accepted: 04/23/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate a moving blocker-based approach in estimating and correcting megavoltage (MV) and kilovoltage (kV) scatter contamination in kV cone-beam computed tomography (CBCT) acquired during volumetric modulated arc therapy (VMAT). METHODS AND MATERIALS During the concurrent CBCT/VMAT acquisition, a physical attenuator (i.e., "blocker") consisting of equally spaced lead strips was mounted and moved constantly between the CBCT source and patient. Both kV and MV scatter signals were estimated from the blocked region of the imaging panel, and interpolated into the unblocked region. A scatter corrected CBCT was then reconstructed from the unblocked projections after scatter subtraction using an iterative image reconstruction algorithm based on constraint optimization. Experimental studies were performed on a Catphan® phantom and an anthropomorphic pelvis phantom to demonstrate the feasibility of using a moving blocker for kV-MV scatter correction. RESULTS Scatter induced cupping artifacts were substantially reduced in the moving blocker corrected CBCT images. Quantitatively, the root mean square error of Hounsfield units (HU) in seven density inserts of the Catphan phantom was reduced from 395 to 40. CONCLUSIONS The proposed moving blocker strategy greatly improves the image quality of CBCT acquired with concurrent VMAT by reducing the kV-MV scatter induced HU inaccuracy and cupping artifacts.
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Affiliation(s)
- Luo Ouyang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, United States
| | - Huichen Pam Lee
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, United States
| | - Jing Wang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, United States.
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Boydev C, Taleb-Ahmed A, Derraz F, Peyrodie L, Thiran JP, Pasquier D. Development of CBCT-based prostate setup correction strategies and impact of rectal distension. Radiat Oncol 2015; 10:83. [PMID: 25890308 PMCID: PMC4465160 DOI: 10.1186/s13014-015-0386-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 03/20/2015] [Indexed: 12/25/2022] Open
Abstract
Background Cone-beam computed tomography (CBCT) image-guided radiotherapy (IGRT) systems are widely used tools to verify and correct the target position before each fraction, allowing to maximize treatment accuracy and precision. In this study, we evaluate automatic three-dimensional intensity-based rigid registration (RR) methods for prostate setup correction using CBCT scans and study the impact of rectal distension on registration quality. Methods We retrospectively analyzed 115 CBCT scans of 10 prostate patients. CT-to-CBCT registration was performed using (a) global RR, (b) bony RR, or (c) bony RR refined by a local prostate RR using the CT clinical target volume (CTV) expanded with 1-to-20-mm varying margins. After propagation of the manual CT contours, automatic CBCT contours were generated. For evaluation, a radiation oncologist manually delineated the CTV on the CBCT scans. The propagated and manual CBCT contours were compared using the Dice similarity and a measure based on the bidirectional local distance (BLD). We also conducted a blind visual assessment of the quality of the propagated segmentations. Moreover, we automatically quantified rectal distension between the CT and CBCT scans without using the manual CBCT contours and we investigated its correlation with the registration failures. To improve the registration quality, the air in the rectum was replaced with soft tissue using a filter. The results with and without filtering were compared. Results The statistical analysis of the Dice coefficients and the BLD values resulted in highly significant differences (p<10−6) for the 5-mm and 8-mm local RRs vs the global, bony and 1-mm local RRs. The 8-mm local RR provided the best compromise between accuracy and robustness (Dice median of 0.814 and 97% of success with filtering the air in the rectum). We observed that all failures were due to high rectal distension. Moreover, the visual assessment confirmed the superiority of the 8-mm local RR over the bony RR. Conclusion The most successful CT-to-CBCT RR method proved to be the 8-mm local RR. We have shown the correlation between its registration failures and rectal distension. Furthermore, we have provided a simple (easily applicable in routine) and automatic method to quantify rectal distension and to predict registration failure using only the manual CT contours.
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Affiliation(s)
- Christine Boydev
- Signal Processing Laboratory, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne, Switzerland. .,Laboratory of Industrial and Human Automation control, Mechanical engineering and Computer Science, University of Valenciennes and Hainaut-Cambrésis, Valenciennes, France.
| | - Abdelmalik Taleb-Ahmed
- Laboratory of Industrial and Human Automation control, Mechanical engineering and Computer Science, University of Valenciennes and Hainaut-Cambrésis, Valenciennes, France.
| | - Foued Derraz
- Unité de Traitements de Signaux Biomédicaux, Faculté Libre de Médecine, Lille, France.
| | - Laurent Peyrodie
- Unité de Traitements de Signaux Biomédicaux, Hautes Etudes d'Ingénieur, Lille, France.
| | - Jean-Philippe Thiran
- Signal Processing Laboratory, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne, Switzerland. .,Department of Radiology, University Hospital Center (CHUV) and University of Lausanne, Lausanne, Switzerland.
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.
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Herschtal A, Te Marvelde L, Mengersen K, Hosseinifard Z, Foroudi F, Devereux T, Pham D, Ball D, Greer PB, Pichler P, Eade T, Kneebone A, Bell L, Caine H, Hindson B, Kron T. Calculating radiotherapy margins based on Bayesian modelling of patient specific random errors. Phys Med Biol 2015; 60:1793-805. [PMID: 25658193 DOI: 10.1088/0031-9155/60/5/1793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Collected real-life clinical target volume (CTV) displacement data show that some patients undergoing external beam radiotherapy (EBRT) demonstrate significantly more fraction-to-fraction variability in their displacement ('random error') than others. This contrasts with the common assumption made by historical recipes for margin estimation for EBRT, that the random error is constant across patients. In this work we present statistical models of CTV displacements in which random errors are characterised by an inverse gamma (IG) distribution in order to assess the impact of random error variability on CTV-to-PTV margin widths, for eight real world patient cohorts from four institutions, and for different sites of malignancy. We considered a variety of clinical treatment requirements and penumbral widths. The eight cohorts consisted of a total of 874 patients and 27 391 treatment sessions. Compared to a traditional margin recipe that assumes constant random errors across patients, for a typical 4 mm penumbral width, the IG based margin model mandates that in order to satisfy the common clinical requirement that 90% of patients receive at least 95% of prescribed RT dose to the entire CTV, margins be increased by a median of 10% (range over the eight cohorts -19% to +35%). This substantially reduces the proportion of patients for whom margins are too small to satisfy clinical requirements.
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Affiliation(s)
- A Herschtal
- Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia. Faculty of Health Arts and Design, Swinburne University of Technology, Melbourne, Australia
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Cendales R, Torres F, Arbelaez J, Gaitan A, Vasquez J, Bobadilla I. Displacements of fiducial markers in patients with prostate cancer treated with image guided radiotherapy: A single-institution descriptive study. Rep Pract Oncol Radiother 2014; 20:38-42. [PMID: 25535583 DOI: 10.1016/j.rpor.2014.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 04/29/2014] [Accepted: 08/06/2014] [Indexed: 12/25/2022] Open
Abstract
AIM To describe daily displacements when using fiducial markers as surrogates for the target volume in patients with prostate cancer treated with IGRT. BACKGROUND The higher grade of conformity achieved with the use of modern radiation technologies in prostate cancer can increase the risk of geographical miss; therefore, an associated protocol of IGRT is recommended. MATERIALS AND METHODS A single-institution, retrospective, consecutive study was designed. 128 prostate cancer patients treated with daily on-line IGRT based on 2D kV orthogonal images were included. Daily displacement of the fiducial markers was considered as the difference between the position of the patient when using skin tattoos and the position after being relocated using fiducial markers. Measures of central tendency and dispersion were used to describe fiducial displacements. RESULTS The implant itself took a mean time of 15 min. We did not detect any complications derived from the implant. 4296 sets of orthogonal images were identified, 128 sets of images corresponding to treatment initiation were excluded; 91 (2.1%) sets of images were excluded from the analysis after having identified that these images contained extreme outlier values. If IGRT had not been performed 25%, 10% or 5% of the treatments would have had displacements superior to 4, 7 or 9 mm respectively in any axis. CONCLUSIONS Image guidance is required when using highly conformal techniques; otherwise, at least 10% of daily treatments could have significant displacements. IGRT based on fiducial markers, with 2D kV orthogonal images is a convenient and fast method for performing image guidance.
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Zhang T, Wang W, Li Y, Jin J, Wang S, Song Y, Liu Y. Inter- and intrafractional setup errors and baseline shifts of fiducial markers in patients with liver tumors receiving free-breathing postoperative radiation analyzed by cone-beam computed tomography. J Appl Clin Med Phys 2014; 15:4914. [PMID: 25493517 PMCID: PMC5711118 DOI: 10.1120/jacmp.v15i6.4914] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 07/08/2014] [Accepted: 06/30/2014] [Indexed: 12/25/2022] Open
Abstract
This study was to evaluate the interfractional and intrafractional setup errors and baseline shifts of golden fiducial markers in patients receiving postoperative radiotherapy (RT) using cone‐beam computed tomography (CBCT) in order to calculate PTV margins for patients with liver cancer. Twelve patients with liver tumors underwent postoperative RT. CBCT images were acquired before and after the treatment. Off‐line vertebral body match and fiducial marker match were used, respectively. The results of vertebral body match represented the setup errors of the patients, while the results of fiducial marker match represented the absolute position errors of the target volume. Baseline shifts of the target volume were calculated as the absolute target position errors minus setup errors. A total of 12 patients with 214 acquisitions of CBCTs were analyzed. Both Σ and σ of setup errors and baseline shifts in left–right (L/R), superior–inferior (S/I), and anterior–posterior(A/P) directions were calculated, including interfractional and intrafractional uncertainties. Planning target volume (PTV) margins were calculated according to margin=2.5Σ+0.7σ. Margins of 1.8 mm, 3.8 mm, and 1.4 mm in L/R, S/I, and A/P directions are needed to compensate intrafractional errors when daily online CBCT correction is used. When CBCT correction with no action level (NAL) protocol is used, PTV margin should be 2.6 mm, 5.9 mm, and 2.6 mm in L/R, S/I, and A/P directions. Margins of 5.5 mm, 14.6 mm, and 7.2 mm were needed to compensate the baseline shifts when electronic portal imaging devices (EPID) or CBCT with bone match is used for online correction of setup error. PACS number: 87.55.‐x
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Affiliation(s)
- Tao Zhang
- Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College.
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Calculation of planning margins for different verification techniques in radical prostate radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2014. [DOI: 10.1017/s1460396913000101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractPurposeTo calculate and compare planning target volume (PTV) margins for an offline 3 mm tolerance, daily bony anatomy verification, tattoo alignment and online prostate marker matching with those currently used at our institution.MethodsSeventy patients had offline bony anatomy megavoltage verification. 23 different patients underwent fiducial marker matching using daily online kilovoltage verification. Systematic and random errors were measured in the right–left (RL), superior–inferior (SI) and anterior–posterior (AP) directions. Geometric uncertainties from literature were used to help calculate the margins.ResultsPTV margins (mm) were 7 RL, 12 SI and AP (3 mm tolerance offline bony), 6 RL, 11 SI and AP (daily online bony), 8 RL, 12 SI and AP (tattoo alignment) and 5 RL, 8 SI and 6 AP (online daily prostate marker correction).ConclusionsOur current margins for conformal radiotherapy patients are too small for phase 2 in the SI and AP directions. Implementing online daily bony anatomy matching would not reduce the PTV margin significantly. Online daily marker correction showed current PTV71 Gy margins as excessive by (mm) 5 RL, 2 SI and 4 anterior.
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Dosimetric effects of prone and supine positions on post-implant assessments for prostate brachytherapy. J Contemp Brachytherapy 2013; 5:122-6. [PMID: 24143145 PMCID: PMC3797408 DOI: 10.5114/jcb.2013.37695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/18/2013] [Accepted: 09/26/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Post-implant dosimetric assessment is essential for optimal care of patients receiving prostate brachytherapy. In most institutions, post-implant computed tomography (CT) is performed in the supine position. This study aimed to assess variability in dosimetric parameters with postural changes during acquisition of post-implant CT scans. MATERIAL AND METHODS In total, 85 consecutive patients were enrolled in this study. Fifty-three patients underwent seed implantation alone, and the remaining 32 received a combination of seed implantation and external beam radiotherapy. For post-implant analyses, CT scans were obtained in two patient positions, supine and prone. To evaluate differences in dosimetric parameters associated with postural change, the dosimetric data obtained in the supine position were defined as the standard. RESULTS The median prostate volume was 22.4 ml in the supine and 22.5 ml in the prone position (p = 0.51). The median prostate D90 was 120.1% in the supine and 120.3% in the prone position, not significantly different. The mean prostate V100 was 97.1% in the supine and 97.0% in the prone position, again not significantly different. Median rectal V100 in supine and prone positions were 0.42 ml and 0.33 ml, respectively (p < 0.01). Rectal D2cc was also significantly decreased in the prone as compared with the supine position (median, 59.1% vs. 63.6%; p < 0.01). A larger post-implant prostate volume was associated with decreased rectal doses in the prone position. CONCLUSIONS Though there were no significant differences among prostate D90 assessments according to postural changes, our results suggest that post-implant rectal doses decreased in the prone position.
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Radiation therapist perspectives on cone-beam computed tomography practices and response to information. JOURNAL OF RADIOTHERAPY IN PRACTICE 2013. [DOI: 10.1017/s1460396913000149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroductionWith recent technological advances in image-guided radiation therapy (IGRT), through cone-beam computed tomography (CBCT), more image-related clinical information is being collected, at more frequent intervals throughout the treatment course. As radiation therapy (RT) programmes further develop IGRT technology, the aim of this study is to assess whether the distribution and communication of professional responsibilities is evolving to ensure appropriate use of the technology.MethodsRadiation therapists practicing at any of the 14 Ontario RT centres were sent an electronic survey (n = 400). Closed-ended quantitative items addressed perceptions regarding policies, comfort, and professional responsibility in addressing CBCT concerns. Focus was on gynaecological, lung, head and neck (H&N) disease sites. Options for qualitative comments and explanations were included where appropriate.ResultsSeventy-nine surveys were submitted. Respondents from 12/14 (85·7%) centres used CBCT for at least one of three disease sites, most commonly on a daily basis. Five of these centres (41·7%) did not require radiation oncologist CBCT review, with others requiring it Day 1 or weekly. Potential CBCT observations of concern were grouped as set-up issues, tumour changes, organ-at-risk (OAR) changes, contour changes and ancillary findings (especially lung and airway changes). Respondents believed they consulted another professional about a CBCT in 20·2% of H&N patients, 19·6% of lung patients and 9·7% of gynaecological patients. The level of comfort in doing so varied from 77·0% for H&N to 89·5% for lung. Respondents were most likely to believe themselves responsible for changes in OARs (92·2% believing themselves responsible), and least likely for ancillary findings (62·7%).ConclusionsThrough preliminary insight from Ontario therapists, a degree of inconsistency is apparent between perceptions, practices and assigned roles in the management of CBCT information. Clear definition of the scope and nature of therapists’ responsibility for interpreting and addressing changes on CBCT images should be developed within each centre.
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Mutanga TF, de Boer HC, Rajan V, Dirkx ML, Incrocci L, Heijmen BJ. Day-to-Day Reproducibility of Prostate Intrafraction Motion Assessed by Multiple kV and MV Imaging of Implanted Markers During Treatment. Int J Radiat Oncol Biol Phys 2012; 83:400-7. [DOI: 10.1016/j.ijrobp.2011.05.049] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 05/04/2011] [Accepted: 05/22/2011] [Indexed: 11/28/2022]
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Herschtal A, Foroudi F, Greer PB, Eade TN, Hindson BR, Kron T. Finding the optimal statistical model to describe target motion during radiotherapy delivery—a Bayesian approach. Phys Med Biol 2012; 57:2743-55. [DOI: 10.1088/0031-9155/57/9/2743] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bissonnette JP, Balter PA, Dong L, Langen KM, Lovelock DM, Miften M, Moseley DJ, Pouliot J, Sonke JJ, Yoo S. Quality assurance for image-guided radiation therapy utilizing CT-based technologies: A report of the AAPM TG-179. Med Phys 2012; 39:1946-63. [PMID: 22482616 DOI: 10.1118/1.3690466] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Nakamatsu K, Nishimura Y, Kanamori S, Koike R, Tachibana I, Nishikawa T, Shibata T. Randomized clinical trial of postoperative strontium-90 radiation therapy for pterygia: treatment using 30 Gy/3 fractions vs. 40 Gy/4 fractions. Strahlenther Onkol 2011; 187:401-5. [PMID: 21713395 DOI: 10.1007/s00066-011-2212-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 03/16/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Postoperative adjuvant treatment with strontium-90 radiation therapy (RT) is a proven technique for reducing the recurrence of pterygium. This randomized trial was conducted to evaluate whether a total dose of 40 Gy provides a better local control rate than a total dose of 30 Gy for surgically resected pterygia. PATIENTS AND METHODS A single institutional randomized trial was conducted. Between 1999 and 2003, 74 pterygia in 71 patients were randomly allocated to 30 Gy/3 fractions/15 days (arm A) or to 40 Gy/4 fractions/22 days (arm B). Only primary pterygia for which RT could be started within 3 days of surgical resection were included. Postoperative RT was given by a strontium-90 eye applicator, and a dose of 10 Gy per fraction was delivered in weekly fractions (day 1, 8, 15, 22). RESULTS Of the 74 pterygia treated, 73 in 70 patients were analyzed. Of the 73 pterygia, 41 were allocated to arm A, and the remaining 32 to arm B. The 2-year local control rates for arm A and arm B were 85% and 75%, respectively, without significant difference. No serious acute and late complications were noted in either arm. CONCLUSION Our new standard fractionation for postoperative RT for pterygia is 30 Gy/3 fractions.
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Affiliation(s)
- Kiyoshi Nakamatsu
- Department of Radiation Oncology, Kinki University Faculty of Medicine, Osaka, Japan.
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Housri N, Ning H, Ondos J, Choyke P, Camphausen K, Citrin D, Arora B, Shankavaram U, Kaushal A. Parameters favorable to intraprostatic radiation dose escalation in men with localized prostate cancer. Int J Radiat Oncol Biol Phys 2011; 80:614-20. [PMID: 20932672 PMCID: PMC3580994 DOI: 10.1016/j.ijrobp.2010.06.050] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Revised: 05/15/2010] [Accepted: 06/29/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify , within the framework of a current Phase I trial, whether factors related to intraprostatic cancer lesions (IPLs) or individual patients predict the feasibility of high-dose intraprostatic irradiation. METHODS AND MATERIALS Endorectal coil MRI scans of the prostate from 42 men were evaluated for dominant IPLs. The IPLs, prostate, and critical normal tissues were contoured. Intensity-modulated radiotherapy plans were generated with the goal of delivering 75.6 Gy in 1.8-Gy fractions to the prostate, with IPLs receiving a simultaneous integrated boost of 3.6 Gy per fraction to a total dose of 151.2 Gy, 200% of the prescribed dose and the highest dose cohort in our trial. Rectal and bladder dose constraints were consistent with those outlined in current Radiation Therapy Oncology Group protocols. RESULTS Dominant IPLs were identified in 24 patients (57.1%). Simultaneous integrated boosts (SIB) to 200% of the prescribed dose were achieved in 12 of the 24 patients without violating dose constraints. Both the distance between the IPL and rectum and the hip-to-hip patient width on planning CT scans were associated with the feasibility to plan an SIB (p = 0.002 and p = 0.0137, respectively). CONCLUSIONS On the basis of this small cohort, the distance between an intraprostatic lesion and the rectum most strongly predicted the ability to plan high-dose radiation to a dominant intraprostatic lesion. High-dose SIB planning seems possible for select intraprostatic lesions.
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Affiliation(s)
- Nadine Housri
- Radiation Oncology Branch Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Holly Ning
- Radiation Oncology Branch Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - John Ondos
- Radiation Oncology Branch Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Kevin Camphausen
- Radiation Oncology Branch Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Deborah Citrin
- Radiation Oncology Branch Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Barbara Arora
- Radiation Oncology Branch Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Uma Shankavaram
- Radiation Oncology Branch Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Aradhana Kaushal
- Radiation Oncology Branch Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Perks J, Turnbull H, Liu T, Purdy J, Valicenti R. Vector Analysis of Prostate Patient Setup With Image-Guided Radiation Therapy via kV Cone Beam Computed Tomography. Int J Radiat Oncol Biol Phys 2011; 79:915-9. [DOI: 10.1016/j.ijrobp.2010.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 02/23/2010] [Accepted: 04/06/2010] [Indexed: 10/24/2022]
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Graf R, Boehmer D, Budach V, Wust P. Residual translational and rotational errors after kV X-ray image-guided correction of prostate location using implanted fiducials. Strahlenther Onkol 2010; 186:544-50. [PMID: 20936461 DOI: 10.1007/s00066-010-2030-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 07/19/2010] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the residual errors and required safety margins after stereoscopic kilovoltage (kV) X-ray target localization of the prostate in image-guided radiotherapy (IGRT) using internal fiducials. PATIENTS AND METHODS Radiopaque fiducial markers (FMs) have been inserted into the prostate in a cohort of 33 patients. The ExacTrac/Novalis Body™ X-ray 6d image acquisition system (BrainLAB AG, Feldkirchen, Germany) was used. Corrections were performed in left-right (LR), anterior-posterior (AP), and superior-inferior (SI) direction. Rotational errors around LR (x-axis), AP (y) and SI (z) have been recorded for the first series of nine patients, and since 2007 for the subsequent 24 patients in addition corrected in each fraction by using the Robotic Tilt Module™ and Varian Exact Couch™. After positioning, a second set of X-ray images was acquired for verification purposes. Residual errors were registered and again corrected. RESULTS Standard deviations (SD) of residual translational random errors in LR, AP, and SI coordinates were 1.3, 1.7, and 2.2 mm. Residual random rotation errors were found for lateral (around x, tilt), vertical (around y, table), and longitudinal (around z, roll) and of 3.2°, 1.8°, and 1.5°. Planning target volume (PTV)-clinical target volume (CTV) margins were calculated in LR, AP, and SI direction to 2.3, 3.0, and 3.7 mm. After a second repositioning, the margins could be reduced to 1.8, 2.1, and 1.8 mm. CONCLUSION On the basis of the residual setup error measurements, the margin required after one to two online X-ray corrections for the patients enrolled in this study would be at minimum 2 mm. The contribution of intrafractional motion to residual random errors has to be evaluated.
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Affiliation(s)
- Reinhold Graf
- Department of Radiation Oncology, Charite - University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany
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A Prospective Study of Intrafraction Prostate Motion in the Prone vs. Supine Position. Int J Radiat Oncol Biol Phys 2010; 77:165-70. [DOI: 10.1016/j.ijrobp.2009.04.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 04/22/2009] [Accepted: 04/23/2009] [Indexed: 11/20/2022]
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Niyazi M, Bartenstein P, Belka C, Ganswindt U. Choline PET based dose-painting in prostate cancer--modelling of dose effects. Radiat Oncol 2010; 5:23. [PMID: 20298546 PMCID: PMC2848061 DOI: 10.1186/1748-717x-5-23] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 03/18/2010] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Several randomized trials have documented the value of radiation dose escalation in patients with prostate cancer, especially in patients with intermediate risk profile. Up to now dose escalation is usually applied to the whole prostate. IMRT and related techniques currently allow for dose escalation in sub-volumes of the organ. However, the sensitivity of the imaging modality and the fact that small islands of cancer are often dispersed within the whole organ may limit these approaches with regard to a clear clinical benefit. In order to assess potential effects of a dose escalation in certain sub-volumes based on choline PET imaging a mathematical dose-response model was developed. METHODS Based on different assumptions for alpha/beta, gamma 50, sensitivity and specificity of choline PET, the influence of the whole prostate and simultaneous integrated boost (SIB) dose on tumor control probability (TCP) was calculated. Based on the given heterogeneity of all potential variables certain representative permutations of the parameters were chosen and, subsequently, the influence on TCP was assessed. RESULTS Using schedules with 74 Gy within the whole prostate and a SIB dose of 90 Gy the TCP increase ranged from 23.1% (high detection rate of choline PET, low whole prostate dose, high gamma 50/ASTRO definition for tumor control) to 1.4% TCP gain (low sensitivity of PET, high whole prostate dose, CN + 2 definition for tumor control) or even 0% in selected cases. The corresponding initial TCP values without integrated boost ranged from 67.3% to 100%. According to a large data set of intermediate-risk prostate cancer patients the resulting TCP gains ranged from 22.2% to 10.1% (ASTRO definition) or from 13.2% to 6.0% (CN + 2 definition). DISCUSSION Although a simplified mathematical model was employed, the presented model allows for an estimation in how far given schedules are relevant for clinical practice. However, the benefit of a SIB based on choline PET seems less than intuitively expected. Only under the assumption of high detection rates and low initial TCP values the TCP gain has been shown to be relevant. CONCLUSIONS Based on the employed assumptions, specific dose escalation to choline PET positive areas within the prostate may increase the local control rates. Due to the lack of exact PET sensitivity and prostate alpha/beta parameter, no firm conclusions can be made. Small variations may completely abrogate the clinical benefit of a SIB based on choline PET imaging.
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Affiliation(s)
- Maximilian Niyazi
- Department of Radiation Oncology, Ludwig-Maximilians-University München, Marchioninistr. 15, 81377 München, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, Ludwig-Maximilians-University München, Marchioninistr. 15, 81377 München, Germany
| | - Claus Belka
- Department of Radiation Oncology, Ludwig-Maximilians-University München, Marchioninistr. 15, 81377 München, Germany
| | - Ute Ganswindt
- Department of Radiation Oncology, Ludwig-Maximilians-University München, Marchioninistr. 15, 81377 München, Germany
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Noel CE, Santanam L, Olsen JR, Baker KW, Parikh PJ. An automated method for adaptive radiation therapy for prostate cancer patients using continuous fiducial-based tracking. Phys Med Biol 2010; 55:65-82. [PMID: 19949260 DOI: 10.1088/0031-9155/55/1/005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Electromagnetic tracking technology is primarily used for continuous prostate localization during radiotherapy, but offers potential value for evaluation of dosimetric coverage and adequacy of treatment for dynamic targets. We developed a highly automated method for daily computation of cumulative dosimetric effects of intra- and inter-fraction target motion for prostate cancer patients using fiducial-based electromagnetic tracking. A computer program utilizing real-time tracking data was written to (1) prospectively determine appropriate rotational/translational motion limits for patients treated with continuous isocenter localization; (2) retrospectively analyze dosimetric target coverage after daily treatment, and (3) visualize three-dimensional rotations and translations of the prostate with respect to the planned target volume and dose matrix. We present phantom testing and a patient case to validate and demonstrate the utility of this application. Gamma analysis of planar dose computed by our application demonstrated accuracy within 1%/1 mm. Dose computation of a patient treatment revealed high variation in minimum dose to the prostate (D(min)) over 40 fractions and a drop in the D(min) of approximately 8% between a 5 mm and a 3 mm PTV margin plan. The infrastructure has been created for patient-specific treatment evaluation using continuous tracking data. This application can be used to increase confidence in treatment delivery to targets influenced by motion.
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Affiliation(s)
- C E Noel
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, St Louis, MO 63110, USA
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Herrmann MKA, Gsänger T, Strauss A, Kertesz T, Wolff HA, Christiansen H, Vorwerk H, Hess CF, Hille A. The impact of prostate volume changes during external-beam irradiation in consequence of HDR brachytherapy in prostate cancer treatment. Strahlenther Onkol 2009; 185:397-403. [DOI: 10.1007/s00066-009-1942-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 03/05/2009] [Indexed: 10/20/2022]
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