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Steiner E, Healy B, Baldock C. Dose from imaging at the time of treatment should be reduced. Phys Eng Sci Med 2023; 46:959-962. [PMID: 37436603 DOI: 10.1007/s13246-023-01298-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Affiliation(s)
- Elisabeth Steiner
- Institute for Radiation Oncology and Radiotherapy, LK Wiener Neustadt, Wiener Neustadt, Austria
| | - Brendan Healy
- Australian Clinical Dosimetry Service, Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Australia
| | - Clive Baldock
- Graduate Research School, Western Sydney University, Penrith, NSW, 2747, Australia.
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Morel A, Prunaretty J, Trauchessec D, Ailleres N, Fenoglietto P, Azria D. Comprehensive commissioning and quality assurance validation of Ethos™ therapy. Cancer Radiother 2023; 27:355-361. [PMID: 37085341 DOI: 10.1016/j.canrad.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 04/23/2023]
Abstract
PURPOSE Adaptive radiotherapy with the Ethos® therapy Varian system has been recently implemented at the Montpellier Cancer Institute, France. This article details the commissioning performed before the implementation of this new treatment planning system (TPS). MATERIAL AND METHODS To validate the golden beam data of the machine (Halcyon linear accelerator), percentage depth doses (PDD) and profiles were measured for several field sizes and at different depths with a microdiamond chamber. The final doses calculated for different plan types with the Ethos Acuros XB algorithm and the Halcyon Eclipse Analytic Anisotropic Algorithm were compared using the gamma index method. Lastly, for the patient quality assurance (QA) process, the patient treatment plan results obtained with the Mobius3D QA platform (Varian) were compared with the portal dosimetry results obtained with Epiqa (Epidos). RESULTS Minor differences were observed for the PDD and profile curves (mean difference of 0.2% and 2%, respectively). The χ index pass rate was above 98% for all measures using the 1%/1mm and 2%/2mm criteria for PDD and profile evaluations. The Ethos AXB algorithm was validated for every configuration (fixed fields, standard IMRT and VMAT fields, and clinical plans) with 2D/3D gamma index values>99%. Seventy-three 3-arcs-VMAT QA plans and 27 9-fields-IMRT QA plans were evaluated. Both showed excellent agreement with the TPS calculations (mean gamma pass rate higher than 99%). No difference was observed between IMRT and VMAT. CONCLUSION The beam delivery, the Ethos AXB algorithm, and the patient QA were comprehensively validated using independent tools.
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Affiliation(s)
- A Morel
- Institut du cancer de Montpellier (ICM), Montpellier, France
| | - J Prunaretty
- Institut du cancer de Montpellier (ICM), Montpellier, France.
| | - D Trauchessec
- Institut du cancer de Montpellier (ICM), Montpellier, France
| | - N Ailleres
- Institut du cancer de Montpellier (ICM), Montpellier, France
| | - P Fenoglietto
- Institut du cancer de Montpellier (ICM), Montpellier, France
| | - D Azria
- Institut du cancer de Montpellier (ICM), Montpellier, France
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Arumugam S, Young T, Do V, Chlap P, Tawfik C, Udovitch M, Wong K, Sidhom M. Assessment of intrafraction motion and its dosimetric impact on prostate radiotherapy using an in-house developed position monitoring system. Front Oncol 2023; 13:1082391. [PMID: 37519787 PMCID: PMC10375704 DOI: 10.3389/fonc.2023.1082391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To implement an in-house developed position monitoring software, SeedTracker, for conventional fractionation prostate radiotherapy, and study the effect on dosimetric impact and intrafraction motion. Methods Thirty definitive prostate radiotherapy patients with implanted fiducial markers were included in the study. All patients were treated with VMAT technique and plans were generated using the Pinnacle planning system using the 6MV beam model for Elekta linear accelerator. The target dose of 60 Gy in 20 fractions was prescribed for 29 of 30 patients, and one patient was treated with the target dose of 78 Gy in 39 fractions. The SeedTracker position monitoring system, which uses the x-ray images acquired during treatment delivery in the Elekta linear accelerator and associated XVI system, was used for online prostate position monitoring. The position tolerance for online verification was progressively reduced from 5 mm, 4 mm, and to 3 mm in 10 patient cohorts to effectively manage the treatment interruptions resulting from intrafraction motion in routine clinical practice. The delivered dose to target volumes and organs at risk in each of the treatment fractions was assessed by incorporating the observed target positions into the original treatment plan. Results In 27 of 30 patients, at least one gating event was observed, with a total of 177 occurrences of position deviation detected in 146 of 619 treatment fractions. In 5 mm, 4 mm, and 3 mm position tolerance cohorts, the position deviations were observed in 13%, 24%, and 33% of treatment fractions, respectively. Overall, the mean (range) deviation of -0.4 (-7.2 to 5.3) mm, -0.9 (-6.1 to 15.6) mm, and -1.7 (-7.0 to 6.1) mm was observed in Left-Right, Anterior-Posterior, and Superior-Inferior directions, respectively. The prostate CTV D99 would have been reduced by a maximum value of 1.3 Gy compared to the planned dose if position deviations were uncorrected, but with corrections, it was 0.3 Gy. Similarly, PTV D98 would have been reduced by a maximum value of 7.6 Gy uncorrected, with this difference reduced to 2.2 Gy with correction. The V60 to the rectum increased by a maximum of 1.0% uncorrected, which was reduced to 0.5%. Conclusion Online target position monitoring for conventional fractionation prostate radiotherapy was successfully implemented on a standard Linear accelerator using an in-house developed position monitoring software, with an improvement in resultant dose to prostate target volume.
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Affiliation(s)
- Sankar Arumugam
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Tony Young
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
| | - Viet Do
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Phillip Chlap
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Christine Tawfik
- Department of Radiation Therapy, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Mark Udovitch
- Department of Radiation Therapy, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Karen Wong
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Mark Sidhom
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
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Wegener E, Samuels J, Sidhom M, Trada Y, Sridharan S, Dickson S, McLeod N, Martin JM. Virtual HDR Boost for Prostate Cancer: Rebooting a Classic Treatment Using Modern Tech. Cancers (Basel) 2023; 15:cancers15072018. [PMID: 37046680 PMCID: PMC10093761 DOI: 10.3390/cancers15072018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Prostate cancer (PC) is the most common malignancy in men. Internal radiotherapy (brachytherapy) has been used to treat PC successfully for over a century. In particular, there is level-one evidence of the benefits of using brachytherapy to escalate the dose of radiotherapy compared with standard external beam radiotherapy approaches. However, the use of PC brachytherapy is declining, despite strong evidence for its improved cancer outcomes. A method using external beam radiotherapy known as virtual high-dose-rate brachytherapy boost (vHDRB) aims to noninvasively mimic a brachytherapy boost radiation dose plan. In this review, we consider the evidence supporting brachytherapy boosts for PC and the continuing evolution of vHDRB approaches, culminating in the current generation of clinical trials, which will help define the role of this emerging modality.
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Affiliation(s)
- Eric Wegener
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
- GenesisCare, Maitland, NSW 2323, Australia
- GenesisCare, Gateshead, NSW 2290, Australia
- Correspondence:
| | - Justin Samuels
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
| | - Mark Sidhom
- Department of Radiation Oncology, Liverpool Hospital, Liverpool, NSW 2170, Australia
| | - Yuvnik Trada
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
| | - Swetha Sridharan
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
- GenesisCare, Gateshead, NSW 2290, Australia
| | - Samuel Dickson
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
| | - Nicholas McLeod
- Department of Urology, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Jarad M. Martin
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
- GenesisCare, Maitland, NSW 2323, Australia
- GenesisCare, Gateshead, NSW 2290, Australia
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Burton A, Beveridge S, Hardcastle N, Lye J, Sanagou M, Franich R. Adoption of respiratory motion management in radiation therapy. Phys Imaging Radiat Oncol 2022; 24:21-29. [PMID: 36148153 PMCID: PMC9485913 DOI: 10.1016/j.phro.2022.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose A survey on the patterns of practice of respiratory motion management (MM) was distributed to 111 radiation therapy facilities to inform the development of an end-to-end dosimetry audit including respiratory motion. Materials and methods The survey (distributed via REDCap) asked facilities to provide information specific to the combinations of MM techniques (breath-hold gating – BHG, internal target volume – ITV, free-breathing gating – FBG, mid-ventilation – MidV, tumour tracking – TT), sites treated (thorax, upper abdomen, lower abdomen), and fractionation regimes (conventional, stereotactic ablative body radiation therapy – SABR) used in their clinic. Results The survey was completed by 78% of facilities, with 98% of respondents indicating that they used at least one form of MM. The ITV approach was common to all MM-users, used for thoracic treatments by 89% of respondents, and upper and lower abdominal treatments by 38%. BHG was the next most prevalent (41% of MM users), with applications in upper abdominal and thoracic treatment sites (28% vs 25% respectively), but minimal use in the lower abdomen (9%). FBG and TT were utilised sparingly (17%, 7% respectively), and MidV was not selected at all. Conclusions Two distinct treatment workflows (including use of motion limitation, imaging used for motion assessment, dose calculation, and image guidance procedures) were identified for the ITV and BHG MM techniques, to form the basis of the initial audit. Thoracic SABR with the ITV approach was common to nearly all respondents, while upper abdominal SABR using BHG stood out as more technically challenging. Other MM techniques were sparsely used, but may be considered for future audit development.
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Jordan B, Muñoz L, Colyer C. Reducing ExacTrac intrafraction imaging uncertainty for prostate stereotactic body radiotherapy using a pre-treatment CBCT. Phys Eng Sci Med 2022; 45:547-558. [PMID: 35438452 DOI: 10.1007/s13246-022-01121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
This study evaluated the intrafractional auto-matching uncertainties of prostate-implanted fiducial markers when using the ExacTrac v6.5 (Brainlab, Feldkirchen, Germany) X-ray stereoscopic system. A customised phantom with 3 implanted gold seeds was initially positioned at the isocentre using a cone beam CT (CBCT) prior to intrafractional imaging. Progressive offsets were applied to the phantom in all six directions (3 translational, 3 rotational) of 0 mm, 1 mm, 2 mm, 0°, 1° and 2°. Subsequently, the ability of the ExacTrac image-matching functions to detect and correct these offsets was tested. For comparison, this procedure was repeated, but without a CBCT for pre-treatment positioning. The auto-matching uncertainties when a CBCT was introduced into the workflow were significantly reduced, and overall, the auto-matching statistics using the implanted marker (seeds) matching function was found to be more precise than the bony anatomy function in-phantom. The total standard deviations for the translational shifts using the implanted marker and bony anatomy functions respectively were 0.1 mm and 0.3 mm vertically, 0.1 mm and 0.3 mm longitudinally, and 0.1 mm and 0.4 mm laterally. The standard deviations for the rotational shifts using the implanted marker and bony anatomy matching functions respectively were 0.2° and 1.2° for the yaw (angle vert), 0.3° and 1.1° for the pitch (angle long), and 0.2° and 1.2° for the roll (angle lat) directions. The reduced uncertainties from introducing a CBCT for initial localisation resulted in decreased probability of inhibits due to false positives during treatment.
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Affiliation(s)
- Barry Jordan
- GenesisCare, St. Andrew's Hospital Oncology, Adelaide, SA, Australia.
| | - Luis Muñoz
- GenesisCare, St. Andrew's Hospital Oncology, Adelaide, SA, Australia
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Richardson M, Skehan K, Wilton L, Sams J, Samuels J, Goodwin J, Greer P, Sridharan S, Martin J. Visualising the urethra for prostate radiotherapy planning. J Med Radiat Sci 2021; 68:282-288. [PMID: 34028976 PMCID: PMC8424315 DOI: 10.1002/jmrs.485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/01/2021] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The prostatic urethra is an organ at risk for prostate radiotherapy with genitourinary toxicities a common side effect. Many external beam radiation therapy protocols call for urethral sparing, and with modulated radiotherapy techniques, the radiation dose distribution can be controlled so that maximum doses do not fall within the prostatic urethral volume. Whilst traditional diagnostic MRI sequences provide excellent delineation of the prostate, uncertainty often remains as to the true path of the urethra within the gland. This study aims to assess if a high-resolution isotropic 3D T2 MRI series can reduce inter-observer variability in urethral delineation for radiotherapy planning. METHODS Five independent observers contoured the prostatic urethra for ten patients on three data sets; a 2 mm axial CT, a diagnostic 3 mm axial T2 TSE MRI and a 0.9 mm isotropic 3D T2 SPACE MRI. The observers were blinded from each other's contours. A Dice Similarity Coefficient (DSC) score was calculated using the intersection and union of the five observer contours vs an expert reference contour for each data set. RESULTS The mean DSC of the observer vs reference contours was 0.47 for CT, 0.62 for T2 TSE and 0.78 for T2 SPACE (P < 0.001). CONCLUSIONS The introduction of a 0.9 mm isotropic 3D T2 SPACE MRI for treatment planning provides improved urethral visualisation and can lead to a significant reduction in inter-observer variation in prostatic urethral contouring.
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Affiliation(s)
- Matthew Richardson
- Department of Radiation OncologyCalvary Mater NewcastleWaratahNew South WalesAustralia
| | - Kate Skehan
- Department of Radiation OncologyCalvary Mater NewcastleWaratahNew South WalesAustralia
| | - Lee Wilton
- Department of Radiation OncologyCalvary Mater NewcastleWaratahNew South WalesAustralia
| | - Joshua Sams
- Department of Radiation OncologyCalvary Mater NewcastleWaratahNew South WalesAustralia
| | - Justin Samuels
- Department of Radiation OncologyCalvary Mater NewcastleWaratahNew South WalesAustralia
| | - Jonathan Goodwin
- Department of Radiation OncologyCalvary Mater NewcastleWaratahNew South WalesAustralia
- School of Mathematical and Physical ScienceUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Peter Greer
- Department of Radiation OncologyCalvary Mater NewcastleWaratahNew South WalesAustralia
- School of Mathematical and Physical ScienceUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Swetha Sridharan
- Department of Radiation OncologyCalvary Mater NewcastleWaratahNew South WalesAustralia
| | - Jarad Martin
- Department of Radiation OncologyCalvary Mater NewcastleWaratahNew South WalesAustralia
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNew South WalesAustralia
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Nguyen DT, Keall PJ, Booth JT, Shieh CC, Poulsen PR, O'Brien RT. A real-time IGRT method using a Kalman filter framework to extract 3D positions from 2D projections. Phys Med Biol 2021; 66. [PMID: 34062512 DOI: 10.1088/1361-6560/ac06e3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/01/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE To estimate 3D prostate motion in real-time during irradiation from 2D prostate positions acquired from a kV imager on a standard linear accelerator utilising a Kalman-Filter (KF) framework. The advantage of this novel method is threefold: (1) eliminating the need of an initial learning period, therefore reducing patient imaging dose, (2) more robust against measurement noise and (3) more computationally efficient. METHODS A KF framework was implemented to estimate 3D motion from 2D projection measurements in real-time during prostate cancer treatments. The noise covariance matrix was estimated from the previous 10 measurements. This method did not require an initial learning period as it was initialised using a population covariance matrix. This method was evaluated using a ground-truth motion dataset of 17 prostate cancer patients (536 trajectories) measured with electromagnetic transponders. 3D motion was projected onto a rotating imager (SID=180cm) (pixel size=0.388mm) and rotation speed of 6°/s and 2°/s to simulate VMAT treatments. Gantry-varying additive random noise (±5mm) was added to ground-truth measurements to simulate segmentation error and image quality degradation due to the patient's pelvic bones. For comparison, motion was also estimated using the clinically implemented Gaussian PDF method initialised with 600 projections. RESULTS Without noise, the 3D root-mean-square-errors (3D RMSEs) of motion estimated by the KF method were 0.4±0.1mm and 0.3±0.2mm for 2°/s and 6°/s gantry rotation, respectively. With noise, 3D RMSEs of KF estimated motion were 1.1±0.1 mm for both slow and fast gantry rotation scenarios. In comparison, using a Gaussian PDF method, with noise, 3D RMSE was 2±0.1 mm for both gantry rotation scenarios. CONCLUSION This work presents a fast and accurate method for real-time 2D to 3D motion estimation using a Kalman lter approach to handle the random-walk component of prostate cancer motion. This method has sub-mm accuracy and is highly robust against measurement noise.
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Affiliation(s)
- Doan Trang Nguyen
- Radiation Physics Laboratory - School of Medicine, University of Sydney, Blackburn building, The University of Sydney, Sydney, New South Wales, 2006, AUSTRALIA
| | - Paul J Keall
- Sydney Medical School - Central, University of Sydney, Edward Ford Building A27, The University of Sydney, NSW 2006, Sydney, AUSTRALIA
| | - Jeremy Todd Booth
- Radiation Oncology, Northern Sydney Cancer Centre, Level 1 Royal North Shore Hospital, St Leonards, New South Wales, 2065, AUSTRALIA
| | - Chun-Chien Shieh
- Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, The University of Sydney, Room 479, Blackburn Building, D06NSW 2006, Australia, Sydney, New South Wales, 2006, AUSTRALIA
| | | | - Ricky T O'Brien
- Radiation Physics Laboratory, Sydney Medical School, University of Sydney, NSW 2006, Camperdown, New South Wales, 2039, AUSTRALIA
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Keall PJ, Sawant A, Berbeco RI, Booth JT, Cho B, Cerviño LI, Cirino E, Dieterich S, Fast MF, Greer PB, Munck Af Rosenschöld P, Parikh PJ, Poulsen PR, Santanam L, Sherouse GW, Shi J, Stathakis S. AAPM Task Group 264: The safe clinical implementation of MLC tracking in radiotherapy. Med Phys 2021; 48:e44-e64. [PMID: 33260251 DOI: 10.1002/mp.14625] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 12/25/2022] Open
Abstract
The era of real-time radiotherapy is upon us. Robotic and gimbaled linac tracking are clinically established technologies with the clinical realization of couch tracking in development. Multileaf collimators (MLCs) are a standard equipment for most cancer radiotherapy systems, and therefore MLC tracking is a potentially widely available technology. MLC tracking has been the subject of theoretical and experimental research for decades and was first implemented for patient treatments in 2013. The AAPM Task Group 264 Safe Clinical Implementation of MLC Tracking in Radiotherapy Report was charged to proactively provide the broader radiation oncology community with (a) clinical implementation guidelines including hardware, software, and clinical indications for use, (b) commissioning and quality assurance recommendations based on early user experience, as well as guidelines on Failure Mode and Effects Analysis, and (c) a discussion of potential future developments. The deliverables from this report include: an explanation of MLC tracking and its historical development; terms and definitions relevant to MLC tracking; the clinical benefit of, clinical experience with and clinical implementation guidelines for MLC tracking; quality assurance guidelines, including example quality assurance worksheets; a clinical decision pathway, future outlook and overall recommendations.
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Affiliation(s)
- Paul J Keall
- ACRF Image X Institute, The University of Sydney Faculty of Medicine and Health, Sydney, NSW, 2006, Australia
| | - Amit Sawant
- Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Ross I Berbeco
- Radiation Oncology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Jeremy T Booth
- Radiation Oncology, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, 2006, Australia
| | - Byungchul Cho
- Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Laura I Cerviño
- Radiation Medicine & Applied Sciences, Radiation Oncology PET/CT Center, UC San Diego, LA Jolla, CA, 92093-0865, USA.,Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065-6007, USA
| | - Eileen Cirino
- Lahey Health and Medical Center, Burlington, MA, 01805, USA
| | - Sonja Dieterich
- Department of Radiation Oncology, UC Davis Medical Center, Sacramento, CA, 95618, USA
| | - Martin F Fast
- Department of Radiotherapy, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
| | - Peter B Greer
- Calvary Mater Newcastle, Newcastle, NSW, 2310, Australia
| | - Per Munck Af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Parag J Parikh
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Per Rugaard Poulsen
- Department of Oncology and Danish Center for Particle Therapy, Aarhus University Hospital, 8200, Aarhus, Denmark
| | - Lakshmi Santanam
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065-6007, USA
| | | | - Jie Shi
- Sun Nuclear Corp, Melbourne, FL, 32940, USA
| | - Sotirios Stathakis
- University of Texas Health San Antonio Cancer Center, San Antonio, TX, 78229, USA
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10
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Mejnertsen L, Hewson E, Nguyen DT, Booth J, Keall P. Dose-based optimisation for multi-leaf collimator tracking during radiation therapy. Phys Med Biol 2021; 66:065027. [PMID: 33607648 DOI: 10.1088/1361-6560/abe836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Motion in the patient anatomy causes a reduction in dose delivered to the target, while increasing dose to healthy tissue. Multi-leaf collimator (MLC) tracking has been clinically implemented to adapt dose delivery to account for intrafraction motion. Current methods shift the planned MLC aperture in the direction of motion, then optimise the new aperture based on the difference in fluence. The drawback of these methods is that 3D dose, a function of patient anatomy and MLC aperture sequence, is not properly accounted for. To overcome the drawback of current fluence-based methods, we have developed and investigated real-time adaptive MLC tracking based on dose optimisation. A novel MLC tracking algorithm, dose optimisation, has been developed which accounts for the moving patient anatomy by optimising the MLC based on the dose delivered during treatment, simulated using a simplified dose calculation algorithm. The MLC tracking with dose optimisation method was applied in silico to a prostate cancer VMAT treatment dataset with observed intrafraction motion. Its performance was compared to MLC tracking with fluence optimisation and, as a baseline, without MLC tracking. To quantitatively assess performance, we computed the dose error and 3D γ failure rate (2 mm/2%) for each fraction and method. Dose optimisation achieved a γ failure rate of (4.7 ± 1.2)% (mean and standard deviation) over all fractions, which was significantly lower than fluence optimisation (7.5 ± 2.9)% (Wilcoxon sign-rank test p < 0.01). Without MLC tracking, a γ failure rate of (15.3 ± 12.9)% was achieved. By considering the accumulation of dose in the moving anatomy during treatment, dose optimisation is able to optimise the aperture to actively target regions of underdose while avoiding overdose.
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Affiliation(s)
- Lars Mejnertsen
- ACRF Image X Institute, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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11
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Cetnar A, Ayan AS, Graeper G, Weldon M, Woods K, Klamer B, Pan X, Martin DD, Diaz DA, Gupta N. Prospective dual-surrogate validation study of periodic imaging during treatment for accurately monitoring intrafraction motion of prostate cancer patients. Radiother Oncol 2021; 157:40-46. [PMID: 33484751 DOI: 10.1016/j.radonc.2021.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE The goal of this prospective study is to validate the use of periodic imaging during treatment with a fiducial marker detection algorithm using radiofrequency transponders for prostate cancer patients undergoing treatment for radiation therapy. MATERIALS AND METHODS Ten male patients were enrolled in this study and treated for prostate cancer with implanted electromagnetic monitoring beacons. We evaluated the accuracy and limitations of Intrafraction Motion Review (IMR) by comparing the known locations of the beacons using the electromagnetic monitoring system to the position data reported from IMR images. RESULTS A total of 4054 images were taken during treatment. The difference in vector magnitude of the two methods is centered around zero (mean: 0.03 cm, SD: 0.16 cm) and Lin's Concordance Correlation Coefficient (CCC) is 0.99 (95% CI: 0.98, 1) overall. The Euclidean distance between the two methods was close to zero (median: 0.09 cm, IQR: 0.06, 0.14 cm). The difference in distance between any two markers was centered around zero (mean: 0.01 cm, SD: 0.12 cm) and Lin's CCC is 0.97 (95% CI: 0.96, 0.98) overall. CONCLUSION The accuracy of the algorithm for detected markers within the 2D images is comparable to electromagnetic monitoring for fiducial identification when detected. IMR could provide an alternate solution for patients with contraindications of use of an electromagnetic monitoring system and a cost effective alternative to the acquisition of an additional system for patient monitoring, but does not provide data for pre-treatment set-up verification and real-time 3D positioning during treatment.
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Affiliation(s)
- Ashley Cetnar
- The Ohio State University, Department of Radiation Oncology, Columbus, United States.
| | - Ahmet S Ayan
- The Ohio State University, Department of Radiation Oncology, Columbus, United States
| | - Gavin Graeper
- The Ohio State University, Department of Radiation Oncology, Columbus, United States
| | - Michael Weldon
- The Ohio State University, Department of Radiation Oncology, Columbus, United States
| | - Kyle Woods
- The Ohio State University, Department of Radiation Oncology, Columbus, United States
| | - Brett Klamer
- The Ohio State University, Department of Biomedical Informatics, Center for Biostatistics, Columbus, United States.
| | - Xueliang Pan
- The Ohio State University, Department of Biomedical Informatics, Center for Biostatistics, Columbus, United States.
| | - Douglas D Martin
- The Ohio State University, Department of Radiation Oncology, Columbus, United States
| | - Dayssy A Diaz
- The Ohio State University, Department of Radiation Oncology, Columbus, United States
| | - Nilendu Gupta
- The Ohio State University, Department of Radiation Oncology, Columbus, United States
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12
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Iramina H, Kitamura A, Nakamura M, Mizowaki T. Image quality evaluation of intra-irradiation cone-beam computed tomography acquired during one- and two-arc prostate volumetric-modulated arc therapy delivery: A phantom study. J Appl Clin Med Phys 2020; 21:231-239. [PMID: 33197105 PMCID: PMC7769406 DOI: 10.1002/acm2.13095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/28/2020] [Accepted: 10/24/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose To evaluate (a) the effects of megavoltage (MV)‐scatter on concurrent kilovoltage (kV) projections (PMVkV) acquired during rotational delivery, and (b) the image quality of intra‐irradiation cone‐beam computed tomography (ii‐CBCT) images acquired during prostate volumetric‐modulated arc therapy (VMAT) delivery. Methods Experiment (1): PMVkVs were acquired with various MV beam parameters using a cylindrical phantom: field size (FS), MV energy (6 or 15 MV), dose rate (DR), and gantry speed. The average pixel values were calculated in a region on each PMVkV which were extracted at eight equally spaced gantry angles. Experiment (2): 11 one‐arc and seven two‐arc 15 MV prostate VMAT plans were used along with a pelvis phantom. One plan was selected from each of arc plans and its MV energy was changed to 6 MV. After PMVkVs were acquired, projections consisting of MV‐scatter only (PMVS) were acquired with closing kV blades and subtracted from PMVkV (PMVScorr). Projections by kV beams only were acquired (PkV). The corresponding CBCT images were reconstructed (CBCTMVkV, CBCTMVScorr, and CBCTkV). The root‐mean‐square errors (RMSEs) were calculated in prostate region and 3D gamma analysis was conducted, in which the CBCT‐number was used instead of doses between ii‐CBCT images and CBCTkV (30 HU/1 mm). Results Experiment (1): The MV‐scatters were dependent on the FSs, MV energies, and DRs. Experiment (2): The median RMSEs for CBCTMVScorr were decreased by 107.5 HU (1‐arc) and 42.9 HU (2‐arc) compared to those for CBCTMVkV. The median GPRs for CBCTMVScorr were 94.7% (1‐arc) and 93.4% (2‐arc), while those for CBCTMVkV were 61.1% and 79.9%, respectively. GPRs for 6 MV plans were smaller than those for 15 MV plans. Conclusions The number of MV‐scatters increased with larger FSs and DRs, and smaller MV energy. The MV‐scatters were corrected on the CBCTMVScorr regardless of the number of arcs.
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Affiliation(s)
- Hiraku Iramina
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Ayaka Kitamura
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Hospital, Kyoto, Japan.,Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Hospital, Kyoto, Japan.,Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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13
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Shi K, Dipuglia A, Booth J, Alnaghy S, Kyme A, Keall P, Nguyen DT. Experimental evaluation of the dosimetric impact of intrafraction prostate rotation using film measurement with a 6DoF robotic arm. Med Phys 2020; 47:6068-6076. [PMID: 32997820 DOI: 10.1002/mp.14502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/02/2020] [Accepted: 08/21/2020] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Tumor motion during radiotherapy can cause a reduction in target dose coverage and an increase in healthy tissue exposure. Tumor motion is not strictly translational and often exhibits complex six degree-of-freedom (6DoF) translational and rotational motion. Although the dosimetric impact of prostate tumor translational motion is well investigated, the dosimetric impact of 6DoF motion has only been studied with simulations or dose reconstruction. This study aims to experimentally quantify the dose error caused by 6DoF motion. The experiment was designed to test the hypothesis that 6DoF motion would cause larger dose errors than translational motion alone through gamma analyses of two-dimensional film measurements. METHODS Four patient-measured intrafraction prostate motion traces and four VMAT 7.25 Gy/Fx SBRT treatment plans were selected for the experiment. The traces represented typical motion patterns, including small-angle rotations (<4°), transient movement, persistent excursion, and erratic rotations (>6°). Gafchromic film was placed inside a custom-designed phantom, held by a high-precision 6DoF robotic arm for dose measurements in the coronal plane during treatment delivery. For each combination of the motion trace and treatment plan, two film measurements were made, one with 6DoF motion and the other with the three-dimensional (3D) translation components of the same trace. A gamma pass rate criteria of 2% relative dose/2 mm distance-to-agreement was used in this study and evaluated for each measurement with respect to the static reference film. Two test thresholds, 90% and 50% of the reference dose, were applied to investigate the difference in dose coverage for the PTV region and surrounding areas, respectively. The hypothesis was tested using a Wilcoxon signed-rank test. RESULTS For each of the 16 plan and motion trace pairs, a reduction in the gamma pass rate was observed for 6DoF motion compared with 3D translational motion. With 90% gamma-test threshold, the reduction was 5.8% ± 7.1% (P < 0.01). With 50% gamma-test threshold, the reduction was 4.1% ± 4.8% (P < 0.01). CONCLUSION For the first time, the dosimetric impact of intrafraction prostate rotation during SBRT treatment was measured experimentally. The experimental results support the hypothesis that 6DoF tumor motion causes higher dose error than translation motion alone.
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Affiliation(s)
- Kehuan Shi
- ACRF Image-X Institute, Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Andrew Dipuglia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jeremy Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,School of Physics, The University of Sydney, Sydney, NSW, Australia
| | - Saree Alnaghy
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Andre Kyme
- School of Biomedical Engineering, University of Sydney, Sydney, NSW, Australia
| | - Paul Keall
- ACRF Image-X Institute, Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Doan Trang Nguyen
- ACRF Image-X Institute, Central Clinical School, University of Sydney, Sydney, NSW, Australia.,School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia
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14
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Hewson EA, Nguyen DT, O'Brien R, Poulsen PR, Booth JT, Greer P, Eade T, Kneebone A, Hruby G, Moodie T, Hayden AJ, Turner SL, Hardcastle N, Siva S, Tai KH, Martin J, Keall PJ. Is multileaf collimator tracking or gating a better intrafraction motion adaptation strategy? An analysis of the TROG 15.01 stereotactic prostate ablative radiotherapy with KIM (SPARK) trial. Radiother Oncol 2020; 151:234-241. [DOI: 10.1016/j.radonc.2020.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/17/2020] [Accepted: 08/16/2020] [Indexed: 12/30/2022]
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15
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Vander Veken L, Dechambre D, Michiels S, Cohilis M, Souris K, Lee JA, Geets X. Improvement of kilovoltage intrafraction monitoring accuracy through gantry angles selection. Biomed Phys Eng Express 2020; 6. [PMID: 35073540 DOI: 10.1088/2057-1976/abb18e] [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: 06/24/2020] [Accepted: 08/21/2020] [Indexed: 11/11/2022]
Abstract
Kilovoltage intrafraction monitoring (KIM) is a method allowing to precisely infer the tumour trajectory based on cone beam computed tomography (CBCT) 2D-projections. However, its accuracy is deteriorated in the case of highly mobile tumours involving hysteresis. A first adaptation of KIM consisting of a prior amplitude based binning step has been developed in order to minimize the errors of the original model (phase-KIM). In this work, we propose enhanced methods (KIMsub-arc optimand phase-KIMsub-arc optim) to improve the accuracy of KIM and phase-KIM which relies on the selection of the optimal starting CBCT gantry angle. Aiming at demonstrating the interest of our approach, we carried out a simulation study and an experimental study: we compared the accuracy of the conventional versus sub-arc optim methods on simulated realistic tumour motions with amplitudes ranging from 5 to 30 mm in 1 mm increments. The same approach was performed using a lung dynamic phantom generating a 30 mm amplitude sinusoidal motion. The results show that for in-silico simulated motions of 10, 20 and 30 mm amplitude, the three-dimensional root mean square error (3D-RMSE) can be reduced by 0.67 mm, 0.91 mm, 0.94 mm and 0.18 mm, 0.25 mm, 0.28 mm using KIMsub-arc optimand phase-KIMsub-arc optimrespectively. Considering all in-silico simulated trajectories, the percentage of errors larger than 1 mm decreases from 21.9% down to 1.6% for KIM (p < 0.001) and from 6.6% down to 1.2% for phase-KIM (p < 0.001). Experimentally, the 3D-RMSE is lowered by 0.5732 mm for KIM and by 0.1 mm for phase-KIM. The percentage of errors larger than 1 mm falls from 39.7% down to 18.5% for KIM and from 23.2% down to 11.1% for phase-KIM. In conclusion, our method efficiently anticipates CBCT gantry angles associated with a significantly better accuracy by using KIM and phase-KIM.
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Affiliation(s)
- Loïc Vander Veken
- Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Université Catholique de Louvain, 1200 Brussels, Belgium
| | - David Dechambre
- Radiotherapy Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Steven Michiels
- Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Université Catholique de Louvain, 1200 Brussels, Belgium.,Department of Oncology, Laboratory of Experimental Radiotherapy, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Marie Cohilis
- Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Université Catholique de Louvain, 1200 Brussels, Belgium.,Department of Oncology, Laboratory of Experimental Radiotherapy, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Kevin Souris
- Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Université Catholique de Louvain, 1200 Brussels, Belgium.,Department of Oncology, Laboratory of Experimental Radiotherapy, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - John Aldo Lee
- Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Xavier Geets
- Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Université Catholique de Louvain, 1200 Brussels, Belgium.,Radiotherapy Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
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Kron T, Metcalfe P, Baldock C. Should ACPSEM develop its own position papers or just adopt those of the AAPM? Phys Eng Sci Med 2020; 43:749-753. [PMID: 32696436 PMCID: PMC7373210 DOI: 10.1007/s13246-020-00900-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC 3000 Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500 Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010 Australia
| | - Peter Metcalfe
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2500 Australia
| | - Clive Baldock
- School of Engineering, College of Science and Engineering, University of Tasmania, Sandy Bay, TAS 7005 Australia
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Rijken J, Sidhom M. An assessment of the ExacTrac intrafraction imaging capabilities for flattening filter free prostate stereotactic body radiotherapy. Phys Eng Sci Med 2020; 43:849-855. [PMID: 32557247 DOI: 10.1007/s13246-020-00884-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/31/2020] [Indexed: 12/31/2022]
Abstract
The uncertainties associated with image matching using the ExacTrac® system (BrainLab, Munich, Germany) have been the subject of investigation in the literature for extra-cranial sites. However, the uncertainties involved in the use of ExacTrac in the presence of higher scatter conditions like that for intrafraction imaging of prostate stereotactic radiotherapy utilising unflattened beams is yet to be determined. A prostate phantom was created with 3 implanted gold fiducial markers. This phantom was shifted by 1 mm and 2 mm amounts in the translational planes and by 1° and 2° amounts in the rotational planes and subsequently imaged by ExacTrac during delivery of a clinical SBRT plan. ExacTrac auto-match results were compared to the known offsets with uncertainties calculated. Calculated shifts were shown to be accurate within one standard deviation of the known offsets. Uncertainties were found to vary considerably among the 6 dimensions with matching in the vertical and angle vertical directions having standard deviations of 0.7 mm and 1.3°, respectively. These results agreed with the literature cases for pre-treatment setup and lower scatter condition IMRT intrafraction delivery. Based on these values, probabilities of intrafraction inhibits were calculated based on patient movement and possible fusion tolerances. While the measured uncertainties are adequately defined in order to calculate appropriate target margins, their relatively large magnitudes made choice of intrafraction fusion tolerances problematic. A degree of compromise between the rate of false positives and false negatives is required when implementing ExacTrac into a SBRT prostate protocol.
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Affiliation(s)
- James Rijken
- Icon Cancer Centre, 480 Specialist Centre, Windsor Gardens, SA, Australia. .,Queensland University of Technology, Brisbane, QLD, Australia.
| | - Mark Sidhom
- GenesisCare, Waratah Private Hospital, Hurstville, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
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18
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Overview of patient preparation strategies to manage internal organ motion during radiotherapy in the pelvis. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:Pelvic internal organs change in volume and position during radiotherapy. This may compromise the efficacy of treatment or worsen its toxicity. There may be limitations to fully correcting these changes using online image guidance; therefore, effective and consistent patient preparation and positioning remain important. This review aims to provide an overview of the extent of pelvic organ motion and strategies to manage this motion.Methods and Materials:Given the breadth of this topic, a systematic review was not undertaken. Instead, existing systematic reviews and individual high-quality studies addressing strategies to manage pelvic organ motion have been discussed. Suggested levels of evidence and grades of recommendation for each strategy have been applied.Results:Various strategies to manage rectal changes have been investigated including diet and laxatives, enemas and rectal emptying tubes and rectal displacement with endorectal balloons (ERBs) and rectal spacers. Bladder-filling protocols and bladder ultrasound have been used to try to standardise bladder volume. Positioning the patient supine, using a full bladder and positioning prone with or without a belly board, has been examined in an attempt to reduce the volume of irradiated small bowel. Some randomised trials have been performed, with evidence to support the use of ERBs, rectal spacers, bladder-filling protocols and the supine over prone position in prostate radiotherapy. However, there was a lack of consistent high-quality evidence that would be applicable to different disease sites within the pelvis. Many studies included small numbers of patients were non-randomised, used less conformal radiotherapy techniques or did not report clinical outcomes such as toxicity.Conclusions:There is uncertainty as to the clinical benefit of many of the commonly adopted interventions to minimise pelvic organ motion. Given this and the limitations in online image guidance compensation, further investigation of adaptive radiotherapy strategies is required.
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19
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Friend G, O'Connor P, Charles P. The effect of megavoltage field size on intrafraction cone-beam CT image quality. Phys Eng Sci Med 2020; 43:711-717. [PMID: 32524451 DOI: 10.1007/s13246-020-00870-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 11/25/2022]
Abstract
To investigate the effects of scatter from a megavoltage treatment beam on intrafraction cone beam CT (CBCT) image quality. The effects of treatment beam field size and phantom geometry were investigated as well as the clinical success of IFI. Intrafraction imaging (IFI) was performed on four phantoms with four different MV field sizes using a 6 MV FFF source. The image quality of the intrafraction CBCT images was compared to that of a baseline CBCT (i.e. with no treatment beam on) and quantified using noise and low contrast visibility. Increasing the kV tube current was explored as a possible method to reduce noise induced by the MV photon scatter in the intrafraction-CBCTs. The clinical success of all IFI patients over a 2 month period was reviewed. Intrafraction-CBCT image quality and low-contrast visibility deteriorated as MV field size increased. The extent of image degradation was found to depend on the mass of the phantom resulting in a more pronounced effect for a pelvic phantom than a thoracic phantom. While increasing the tube current could reduce the noise in the intrafraction-CBCT images, increasing the current by a factor of 4 failed to reach baseline image quality. Anatomy was found to be the primary indication of clinical IFI failure with all observed failures occurring during abdominal treatments. Image quality was found to decrease with increasing MV field size and decrease with increasing treatment anatomy mass. When considering intrafraction imaging clinically, the primary indicator of IFI failure is treatment anatomy. IFI can be used during chest treatments with high success rates but care must be taken for abdominal treatments and failures should be expected.
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Affiliation(s)
| | | | - Paul Charles
- Herston Biofabrication Institute, Brisbane, QLD, Australia
- School of Chemistry and Physics, Queensland University of Technology, Brisbane, QLD, Australia
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20
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Stereotactic ablative body radiation therapy (SABR) in NSW. Phys Eng Sci Med 2020; 43:641-650. [DOI: 10.1007/s13246-020-00866-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
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21
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Keall P, Nguyen DT, O'Brien R, Hewson E, Ball H, Poulsen P, Booth J, Greer P, Hunter P, Wilton L, Bromley R, Kipritidis J, Eade T, Kneebone A, Hruby G, Moodie T, Hayden A, Turner S, Arumugam S, Sidhom M, Hardcastle N, Siva S, Tai KH, Gebski V, Martin J. Real-Time Image Guided Ablative Prostate Cancer Radiation Therapy: Results From the TROG 15.01 SPARK Trial. Int J Radiat Oncol Biol Phys 2020; 107:530-538. [PMID: 32234553 DOI: 10.1016/j.ijrobp.2020.03.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE Kilovoltage intrafraction monitoring (KIM) is a novel software platform implemented on standard radiation therapy systems and enabling real-time image guided radiation therapy (IGRT). In a multi-institutional prospective trial, we investigated whether real-time IGRT improved the accuracy of the dose patients with prostate cancer received during radiation therapy. METHODS AND MATERIALS Forty-eight patients with prostate cancer were treated with KIM-guided SABR with 36.25 Gy in 5 fractions. During KIM-guided treatment, the prostate motion was corrected for by either beam gating with couch shifts or multileaf collimator tracking. A dose reconstruction method was used to evaluate the dose delivered to the target and organs at risk with and without real-time IGRT. Primary outcome was the effect of real-time IGRT on dose distributions. Secondary outcomes included patient-reported outcomes and toxicity. RESULTS Motion correction occurred in ≥1 treatment for 88% of patients (42 of 48) and 51% of treatments (121 of 235). With real-time IGRT, no treatments had prostate clinical target volume (CTV) D98% dose 5% less than planned. Without real-time IGRT, 13 treatments (5.5%) had prostate CTV D98% doses 5% less than planned. The prostate CTV D98% dose with real-time IGRT was closer to the plan by an average of 1.0% (range, -2.8% to 20.3%). Patient outcomes showed no change in the 12-month patient-reported outcomes compared with baseline and no grade ≥3 genitourinary or gastrointestinal toxicities. CONCLUSIONS Real-time IGRT is clinically effective for prostate cancer SABR.
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Affiliation(s)
- Paul Keall
- ACRF Image X Institute, University of Sydney, Sydney, Australia.
| | - Doan Trang Nguyen
- ACRF Image X Institute, University of Sydney, Sydney, Australia; School of Biomedical Engineering, University of Technology, Sydney, Sydney, Australia
| | - Ricky O'Brien
- ACRF Image X Institute, University of Sydney, Sydney, Australia
| | - Emily Hewson
- ACRF Image X Institute, University of Sydney, Sydney, Australia
| | - Helen Ball
- ACRF Image X Institute, University of Sydney, Sydney, Australia
| | - Per Poulsen
- Department of Oncology and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Jeremy Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; School of Physics, University of Sydney, Sydney, Australia
| | - Peter Greer
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, Australia; University of Newcastle, Newcastle, Australia
| | - Perry Hunter
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, Australia
| | - Lee Wilton
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, Australia
| | - Regina Bromley
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - John Kipritidis
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; Northern Clinical School, University of Sydney, Sydney, Australia
| | - Andrew Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; Northern Clinical School, University of Sydney, Sydney, Australia
| | - George Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; Northern Clinical School, University of Sydney, Sydney, Australia
| | - Trevor Moodie
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia
| | - Amy Hayden
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia
| | - Sandra Turner
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia
| | - Sankar Arumugam
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool Hospital, Sydney, Australia
| | - Mark Sidhom
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool Hospital, Sydney, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia; Institute of Medical Physics, University of Sydney, Sydney, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Australia
| | - Keen-Hun Tai
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Jarad Martin
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, Australia; University of Newcastle, Newcastle, Australia
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Pettersson N, Oderinde OM, Murphy J, Simpson D, Cerviño LI. Intrafractional relationship changes between an external breathing signal and fiducial marker positions in pancreatic cancer patients. J Appl Clin Med Phys 2020; 21:153-161. [PMID: 32170900 PMCID: PMC7075406 DOI: 10.1002/acm2.12841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/16/2020] [Accepted: 01/26/2020] [Indexed: 12/25/2022] Open
Abstract
Background and purpose The purpose of this study of pancreatic cancer patients treated with respiratory‐guided stereotactic body radiotherapy (SBRT) on a standard linac was to investigate (a) the intrafractional relationship change (IRC) between a breathing signal and the tumor position, (b) the impact of IRC on the delivered dose, and (c) potential IRC predictors. Materials and methods We retrospectively investigated 10 pancreatic cancer patients with 2–4 implanted fiducial markers in the tumor treated with SBRT. Fluoroscopic images were acquired before and after treatment delivery simultaneously with the abdominal breathing motion. We quantified the IRC as the change in fiducial location for a given breathing amplitude in the left–right (LR), anterior–posterior (AP), and superior–inferior (SI) directions from before to after treatment delivery. The treatment plans were re‐calculated after changing the isocenter coordinates according to the IRCs. Four treatment‐ or patient‐related factors were investigated as potential predictors for IRC using linear models. Results The average (±1 SD) absolute IRCs in the LR, AP, and SI directions were 1.2 ± 1.2 mm, 0.7 ± 0.7 mm, and 1.1 ± 0.8 mm, respectively. The average 3D IRC was 2.0 ± 1.3 mm (range: 0.4–5.3 mm) for a median treatment delivery time of 8.5 min (range: 5.7–19.9 min; n = 31 fractions). The dose coverage of the internal target volume (ITV) decreased by more than 3% points in three of 31 fractions. In those cases, the 3D IRC had been larger than 4.3 mm. The 3D IRC was found to correlate with changes in the minimum breathing amplitude during treatment delivery. Conclusion On average, 2 mm of treatment delivery accuracy was lost due to IRC. Periodical intrafractional imaging is needed to safely deliver respiratory‐guided SBRT.
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Affiliation(s)
- Niclas Pettersson
- Department of Radiation Oncology, University of California San Diego, La Jolla, CA, USA.,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Göteborg, Sweden.,Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Oluwaseyi M Oderinde
- Department of Radiation Oncology, University of California San Diego, La Jolla, CA, USA
| | - James Murphy
- Department of Radiation Oncology, University of California San Diego, La Jolla, CA, USA
| | - Daniel Simpson
- Department of Radiation Oncology, University of California San Diego, La Jolla, CA, USA
| | - Laura I Cerviño
- Department of Radiation Oncology, University of California San Diego, La Jolla, CA, USA.,Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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23
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The accuracy and precision of the KIM motion monitoring system used in the multi‐institutional TROG 15.01 Stereotactic Prostate Ablative Radiotherapy with KIM (SPARK) trial. Med Phys 2019; 46:4725-4737. [DOI: 10.1002/mp.13784] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 01/19/2023] Open
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Muurholm CG, Ravkilde T, Skouboe S, Eade T, Nguyen DT, Booth J, Keall PJ, Poulsen PR. Dose reconstruction including dynamic six-degree of freedom motion during prostate radiotherapy. ACTA ACUST UNITED AC 2019. [DOI: 10.1088/1742-6596/1305/1/012053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Martin J, Keall P, Siva S, Greer P, Christie D, Moore K, Dowling J, Pryor D, Chong P, McLeod N, Raman A, Lynam J, Smart J, Oldmeadow C, Tang CI, Murphy DG, Millar J, Tai KH, Holloway L, Reeves P, Hayden A, Lim T, Holt T, Sidhom M. TROG 18.01 phase III randomised clinical trial of the Novel Integration of New prostate radiation schedules with adJuvant Androgen deprivation: NINJA study protocol. BMJ Open 2019; 9:e030731. [PMID: 31434782 PMCID: PMC6707760 DOI: 10.1136/bmjopen-2019-030731] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Stereotactic body radiotherapy (SBRT) is a non-invasive alternative to surgery for the treatment of non-metastatic prostate cancer (PC). The objectives of the Novel Integration of New prostate radiation schedules with adJuvant Androgen deprivation (NINJA) clinical trial are to compare two emerging SBRT regimens for efficacy with technical substudies focussing on MRI only planning and the use of knowledge-based planning (KBP) to assess radiotherapy plan quality. METHODS AND ANALYSIS Eligible patients must have biopsy-proven unfavourable intermediate or favourable high-risk PC, have an Eastern Collaborative Oncology Group (ECOG) performance status 0-1 and provide written informed consent. All patients will receive 6 months in total of androgen deprivation therapy. Patients will be randomised to one of two SBRT regimens. The first will be 40 Gy in five fractions given on alternating days (SBRT monotherapy). The second will be 20 Gy in two fractions given 1 week apart followed 2 weeks later by 36 Gy in 12 fractions given five times per week (virtual high-dose rate boost (HDRB)). The primary efficacy outcome will be biochemical clinical control at 5 years. Secondary endpoints for the initial portion of NINJA look at the transition of centres towards MRI only planning and the impact of KBP on real-time (RT) plan assessment. The first 150 men will demonstrate accrual feasibility as well as addressing the KBP and MRI planning aims, prior to proceeding with total accrual to 472 patients as a phase III randomised controlled trial. ETHICS AND DISSEMINATION NINJA is a multicentre cooperative clinical trial comparing two SBRT regimens for men with PC. It builds on promising results from several single-armed studies, and explores radiation dose escalation in the Virtual HDRB arm. The initial component includes novel technical elements, and will form an important platform set for a definitive phase III study. TRIAL REGISTRATION NUMBER ANZCTN 12615000223538.
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Affiliation(s)
- Jarad Martin
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Paul Keall
- Radiation Physics Laboratory, University of Sydney, Sydney, New South Wales, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Greer
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
- School of Mathematical and Physical Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Kevin Moore
- Department of Medical Physics, University of California San Diego, La Jolla, California, USA
| | - Jason Dowling
- The Australian e-Health Research Centre, CSIRO, Canberra, Australian Capital Territory, Australia
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital Health Service District, Woolloongabba, Queensland, Australia
| | - Peter Chong
- Department of Urology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Nicholas McLeod
- Department of Urology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Avi Raman
- Department of Urology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - James Lynam
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Joanne Smart
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | | | - Colin I Tang
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Declan G Murphy
- Urological Service Team, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jeremy Millar
- Department of Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Keen Hun Tai
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Lois Holloway
- Department of Radiation Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Penny Reeves
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Department of Health Research Economics, University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Amy Hayden
- Department of Radiation Oncology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Tee Lim
- Genesis Care, Perth, Western Australia, Australia
| | - Tanya Holt
- Radiation Oncology Princess Alexandra Raymond Terrace, Brisbane, Queensland, Australia
| | - Mark Sidhom
- Department of Radiation Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia
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26
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Wolf J, Nicholls J, Hunter P, Nguyen DT, Keall P, Martin J. Dosimetric impact of intrafraction rotations in stereotactic prostate radiotherapy: A subset analysis of the TROG 15.01 SPARK trial. Radiother Oncol 2019; 136:143-147. [DOI: 10.1016/j.radonc.2019.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/26/2019] [Accepted: 04/07/2019] [Indexed: 12/26/2022]
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Lafrenière M, Mahadeo N, Lewis J, Rottmann J, Williams CL. Continuous generation of volumetric images during stereotactic body radiation therapy using periodic kV imaging and an external respiratory surrogate. Phys Med 2019; 63:25-34. [PMID: 31221405 DOI: 10.1016/j.ejmp.2019.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/26/2019] [Accepted: 05/18/2019] [Indexed: 12/25/2022] Open
Abstract
We present a technique for continuous generation of volumetric images during SBRT using periodic kV imaging and an external respiratory surrogate signal to drive a patient-specific PCA motion model. Using the on-board imager, kV radiographs are acquired every 3 s and used to fit the parameters of a motion model so that it matches observed changes in internal patient anatomy. A multi-dimensional correlation model is established between the motion model parameters and the external surrogate position and velocity, enabling volumetric image reconstruction between kV imaging time points. Performance of the algorithm was evaluated using 10 realistic eXtended CArdiac-Torso (XCAT) digital phantoms including 3D anatomical respiratory deformation programmed with 3D tumor positions measured with orthogonal kV imaging of implanted fiducial gold markers. The clinically measured ground truth 3D tumor positions provided a dataset with realistic breathing irregularities, and the combination of periodic on-board kV imaging with recorded external respiratory surrogate signal was used for correlation modeling to account for any changes in internal-external correlation. The three-dimensional tumor positions are reconstructed with an average root mean square error (RMSE) of 1.47 mm, and an average 95th percentile 3D positional error of 2.80 mm compared with the clinically measured ground truth 3D tumor positions. This technique enables continuous 3D anatomical image generation based on periodic kV imaging of internal anatomy without the additional dose of continuous kV imaging. The 3D anatomical images produced using this method can be used for treatment verification and delivered dose computation in the presence of irregular respiratory motion.
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Affiliation(s)
- M Lafrenière
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02215, USA.
| | - N Mahadeo
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02215, USA
| | - J Lewis
- University of California, Los Angeles, CA 90095, USA
| | - J Rottmann
- Paul Scherrer Institute, Forschungsstrasse 111, 5232 Villigen, Switzerland
| | - C L Williams
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, Boston, MA 02215, USA.
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28
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de Leon J, Jameson MG, Rivest-Henault D, Keats S, Rai R, Arumugam S, Wilton L, Ngo D, Liney G, Moses D, Dowling J, Martin J, Sidhom M. Reduced motion and improved rectal dosimetry through endorectal immobilization for prostate stereotactic body radiotherapy. Br J Radiol 2019; 92:20190056. [PMID: 30912956 DOI: 10.1259/bjr.20190056] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE PROMETHEUS (ACTRN12615000223538) is a multicentre clinical trial investigating the feasibility of 19 Gy in 2 fractions of stereotactic body radiotherapy (SBRT) as a boost technique for prostate cancer. The objective of this substudy was to evaluate intrafraction motion using cine MRI and assess the dosimetric impact of using a rectal displacement device (RDD). METHODS The initial 10 patients recruited underwent planning CT and MRI, with and without a RDD. Cine MRI images were captured using an interleaved T2 HASTE sequence in sagittal and axial planes with a temporal resolution of 5.2 s acquired over 4.3 min. Points of interest (POIs) were defined and a validated tracking algorithm measured displacement of these points over the 4.3 min in the anteroposterior, superior-inferior and left-right directions. Plans were generated with and without a RDD to examine the impact on dosimetry. RESULTS There was an overall trend for increasing displacement in all directions as time progressed when no RDD was in situ . points of interest remained comparatively stable with the RDD. In the sagittal plane, the RDD resulted in statistically significant improvement in the range of anteroposterior displacement for the rectal wall, anterior prostate, prostate apex and base. Dosimetrically, the use of a RDD significantly reduced rectal V16, V14 and Dmax, as well as the percentage of posterior rectal wall receiving 8.5 Gy. CONCLUSION The RDD used in stereotactic prostate radiotherapy leads to reduced intrafraction motion of the prostate and rectum, with increasing improvement with time. It also results in significant improvement in rectal wall dosimetry. ADVANCES IN KNOWLEDGE It was found that the rectal displacement device improved prostate stabilization significantly, improved rectum stabilization and dosimetry significantly. The rectal displacement device did not improve target volume dosimetry.
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Affiliation(s)
| | - Michael G Jameson
- 2 Liverpool Cancer Therapy Centre , Liverpool , Australia.,3 Ingham Institute for Applied Medical Research , Liverpool , Australia.,4 Faculty of Medicine, University of New South Wales , Australia
| | | | - Sarah Keats
- 2 Liverpool Cancer Therapy Centre , Liverpool , Australia
| | - Robba Rai
- 2 Liverpool Cancer Therapy Centre , Liverpool , Australia
| | | | - Lee Wilton
- 6 Calvary Mater Newcastle , Newcastle , Australia
| | - Diana Ngo
- 2 Liverpool Cancer Therapy Centre , Liverpool , Australia
| | - Gary Liney
- 2 Liverpool Cancer Therapy Centre , Liverpool , Australia.,3 Ingham Institute for Applied Medical Research , Liverpool , Australia.,4 Faculty of Medicine, University of New South Wales , Australia
| | - Daniel Moses
- 4 Faculty of Medicine, University of New South Wales , Australia
| | - Jason Dowling
- 5 Australian e-Health Research Centre, CSIRO , Herston , Australia
| | - Jarad Martin
- 6 Calvary Mater Newcastle , Newcastle , Australia.,7 Schoolof Medicine and Public Health, University of Newcastle , Newcastle , Australia
| | - Mark Sidhom
- 2 Liverpool Cancer Therapy Centre , Liverpool , Australia.,4 Faculty of Medicine, University of New South Wales , Australia
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29
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Caillet V, O'Brien R, Moore D, Poulsen P, Pommer T, Colvill E, Sawant A, Booth J, Keall P. Technical Note: In silico and experimental evaluation of two leaf-fitting algorithms for MLC tracking based on exposure error and plan complexity. Med Phys 2019; 46:1814-1820. [PMID: 30719723 DOI: 10.1002/mp.13425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Multileaf collimator (MLC) tracking is being clinically pioneered to continuously compensate for thoracic and pelvic motion during radiotherapy. The purpose of this work was to characterize the performance of two MLC leaf-fitting algorithms, direct optimization and piecewise optimization, for real-time motion compensation with different plan complexity and tumor trajectories. METHODS To test the algorithms, both in silico and phantom experiments were performed. The phantom experiments were performed on a Trilogy Varian linac and a HexaMotion programmable motion platform. High and low modulation VMAT plans for lung and prostate cancer cases were used along with eight patient-measured organ-specific trajectories. For both MLC leaf-fitting algorithms, the plans were run with their corresponding patient trajectories. To compare algorithms, the average exposure errors, i.e., the difference in shape between ideal and fitted MLC leaves by the algorithm, plan complexity and system latency of each experiment were calculated. RESULTS Comparison of exposure errors for the in silico and phantom experiments showed minor differences between the two algorithms. The average exposure errors for in silico experiments with low/high plan complexity were 0.66/0.88 cm2 for direct optimization and 0.66/0.88 cm2 for piecewise optimization, respectively. The average exposure errors for the phantom experiments with low/high plan complexity were 0.73/1.02 cm2 for direct and 0.73/1.02 cm2 for piecewise optimization, respectively. The measured latency for the direct optimization was 226 ± 10 ms and for the piecewise algorithm was 228 ± 10 ms. In silico and phantom exposure errors quantified for each treatment plan demonstrated that the exposure errors from the high plan complexity (0.96 cm2 mean, 2.88 cm2 95% percentile) were all significantly different from the low plan complexity (0.70 cm2 mean, 2.18 cm2 95% percentile) (P < 0.001, two-tailed, Mann-Whitney statistical test). CONCLUSIONS The comparison between the two leaf-fitting algorithms demonstrated no significant differences in exposure errors, neither in silico nor with phantom experiments. This study revealed that plan complexity impacts the overall exposure errors significantly more than the difference between the algorithms.
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Affiliation(s)
- Vincent Caillet
- Northern Sydney Cancer Centre, Sydney, NSW, Australia.,ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Ricky O'Brien
- ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Douglas Moore
- Beyond Center for Fundamental Concepts in Science, Arizona State University, Tempe, AZ, USA
| | | | - Tobias Pommer
- Unit of Radiotherapy Physics and Engineering, Karolinska University Hospital, Solna, Sweden
| | - Emma Colvill
- Northern Sydney Cancer Centre, Sydney, NSW, Australia.,ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Amit Sawant
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jeremy Booth
- Northern Sydney Cancer Centre, Sydney, NSW, Australia.,ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Paul Keall
- ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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30
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Liu PZY, Nguyen DT, Feain I, O'Brien R, Keall PJ, Booth JT. Technical Note: Real-time image-guided adaptive radiotherapy of a rigid target for a prototype fixed beam radiotherapy system. Med Phys 2018; 45:4660-4666. [DOI: 10.1002/mp.13143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
- P. Z. Y. Liu
- ACRF Image X Institute; University of Sydney Central Clinical School; Sydney NSW Australia
| | - D. T. Nguyen
- ACRF Image X Institute; University of Sydney Central Clinical School; Sydney NSW Australia
| | - I. Feain
- Leo Cancer Care Pty Ltd.; Eveleigh NSW Australia
| | - R. O'Brien
- ACRF Image X Institute; University of Sydney; Sydney NSW Australia
| | - P. J. Keall
- ACRF Image X Institute; University of Sydney; Sydney NSW Australia
| | - J. T. Booth
- Northern Sydney Cancer Centre; Royal North Shore Hospital; St. Leonards NSW Australia
- School of Physics; University of Sydney; Sydney NSW Australia
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31
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Ravkilde T, Skouboe S, Hansen R, Worm E, Poulsen PR. First online real-time evaluation of motion-induced 4D dose errors during radiotherapy delivery. Med Phys 2018; 45:3893-3903. [PMID: 29869789 DOI: 10.1002/mp.13037] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE In radiotherapy, dose deficits caused by tumor motion often far outweigh the discrepancies typically allowed in plan-specific quality assurance (QA). Yet, tumor motion is not usually included in present QA. We here present a novel method for online treatment verification by real-time motion-including four-dimensional (4D) dose reconstruction and dose evaluation and demonstrate its use during stereotactic body radiotherapy (SBRT) delivery with and without MLC tracking. METHODS Five volumetric-modulated arc therapy (VMAT) plans were delivered with and without MLC tracking to a motion stage carrying a Delta4 dosimeter. The VMAT plans have previously been used for (nontracking) liver SBRT with intratreatment tumor motion recorded by kilovoltage intrafraction monitoring (KIM). The motion stage reproduced the KIM-measured tumor motions in three dimensions (3D) while optical monitoring guided the MLC tracking. Linac parameters and the target position were streamed to an in-house developed software program (DoseTracker) that performed real-time 4D dose reconstructions and 3%/3 mm γ-evaluations of the reconstructed cumulative dose using a concurrently reconstructed planned dose without target motion as reference. Offline, the real-time reconstructed doses and γ-evaluations were validated against 4D dosimeter measurements performed during the experiments. RESULTS In total, 181,120 dose reconstructions and 5,237 γ-evaluations were performed online and in real time with median computation times of 30 ms and 1.2 s, respectively. The mean (standard deviation) difference between reconstructed and measured doses was -1.2% (4.9%) for transient doses and -1.5% (3.9%) for cumulative doses. The root-mean-square deviation between reconstructed and measured motion-induced γ-fail rates was 2.0%-point. The mean (standard deviation) sensitivity and specificity of DoseTracker to predict γ-fail rates above a given threshold was 96.8% (3.5%) and 99.2% (0.4%), respectively, for clinically relevant thresholds between 1% and 30% γ-fail rate. CONCLUSIONS Real-time delivery-specific QA during radiotherapy of moving targets was demonstrated for the first time. It allows supervision of treatment accuracy and action on treatment discrepancy within 2 s with high sensitivity and specificity.
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Affiliation(s)
- Thomas Ravkilde
- Medical Physics, Department of Oncology, Aarhus University Hospital, 8000, Aarhus C, Denmark
| | - Simon Skouboe
- Department of Oncology, Aarhus University Hospital, 8000, Aarhus C, Denmark
| | - Rune Hansen
- Medical Physics, Department of Oncology, Aarhus University Hospital, 8000, Aarhus C, Denmark
| | - Esben Worm
- Medical Physics, Department of Oncology, Aarhus University Hospital, 8000, Aarhus C, Denmark
| | - Per R Poulsen
- Department of Oncology, Aarhus University Hospital, 8000, Aarhus C, Denmark
- Institute for Clinical Medicine, Aarhus University, 8200, Aarhus N, Denmark
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32
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Martin JM, Supiot S, Keall PJ, Catton CN. Moderately hypofractionated prostate external-beam radiotherapy: an emerging standard. Br J Radiol 2018; 91:20170807. [PMID: 29322821 PMCID: PMC6223284 DOI: 10.1259/bjr.20170807] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 01/01/2023] Open
Abstract
Research over recent years has demonstrated that curative external-beam radiotherapy can be safely and efficaciously delivered with roughly half the number of treatments which was previously considered standard. We review the data supporting this change in practice, methods for implementation, as well as emerging future directions.
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Affiliation(s)
- Jarad M Martin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, NSW, Australia
| | - Stephane Supiot
- Département de Radiothérapie, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Paul J Keall
- Radiation Physics Laboratory, Sydney Medical School, University of Sydney, Sydney, New South Wales, NSW, Australia
| | - Charles N Catton
- Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
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33
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The first clinical implementation of real-time image-guided adaptive radiotherapy using a standard linear accelerator. Radiother Oncol 2018; 127:6-11. [DOI: 10.1016/j.radonc.2018.01.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/29/2017] [Accepted: 01/02/2018] [Indexed: 12/18/2022]
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34
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Pryor DI, Turner SL, Tai KH, Tang C, Sasso G, Dreosti M, Woo HH, Wilton L, Martin JM. Moderate hypofractionation for prostate cancer: A user's guide. J Med Imaging Radiat Oncol 2018; 62:232-239. [PMID: 29336109 DOI: 10.1111/1754-9485.12703] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/12/2017] [Indexed: 01/16/2023]
Abstract
Three large randomised controlled trials have been published in the last year demonstrating the non-inferiority of moderate hypofractionation compared to conventional fractionation for localised prostate cancer with respect to both disease control and late toxicity at 5 years. Furthermore, no clinically significant differences in patient-reported outcomes have emerged. More mature follow-up data are now also available from phase 2 studies confirming that moderate hypofractionation is associated with low rates of significant toxicity at 10 years. Moving forward it is likely that appropriate patient selection, integration of androgen deprivation and attention to optimising technique will play a more important role than modest differences in dose-fractionation schedules. Here we briefly review the evidence, discuss issues of patient selection and provide an approach to implementing moderately hypofractionated radiation therapy for prostate cancer in clinical practice.
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Affiliation(s)
- David I Pryor
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,APCRC-Q, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sandra L Turner
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Camperdown, New South Wales, Australia
| | - Keen Hun Tai
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Colin Tang
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Giuseppe Sasso
- Auckland City Hospital, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - Marcus Dreosti
- Genesis Cancer Care, Adelaide, South Australia, Australia
| | - Henry H Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Lee Wilton
- Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Jarad M Martin
- Calvary Mater Newcastle, Waratah, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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35
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Kothari G, Loblaw A, Tree AC, van As NJ, Moghanaki D, Lo SS, Ost P, Siva S. Stereotactic Body Radiotherapy for Primary Prostate Cancer. Technol Cancer Res Treat 2018; 17:1533033818789633. [PMID: 30064301 PMCID: PMC6069023 DOI: 10.1177/1533033818789633] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/07/2018] [Accepted: 06/14/2018] [Indexed: 12/25/2022] Open
Abstract
Prostate cancer is the most common non-cutaneous cancer in males. There are a number of options for patients with localized early stage disease, including active surveillance for low-risk disease, surgery, brachytherapy, and external beam radiotherapy. Increasingly, external beam radiotherapy, in the form of dose-escalated and moderately hypofractionated regimens, is being utilized in prostate cancer, with randomized evidence to support their use. Stereotactic body radiotherapy, which is a form of extreme hypofractionation, delivered with high precision and conformality typically over 1 to 5 fractions, offers a more contemporary approach with several advantages including being non-invasive, cost-effective, convenient for patients, and potentially improving patient access. In fact, one study has estimated that if half of the patients currently eligible for conventional fractionated radiotherapy in the United States were treated instead with stereotactic body radiotherapy, this would result in a total cost savings of US$250 million per year. There is also a strong radiobiological rationale to support its use, with prostate cancer believed to have a low α/β ratio and therefore being preferentially sensitive to larger fraction sizes. To date, there are no published randomized trials reporting on the comparative efficacy of stereotactic body radiotherapy compared to alternative treatment modalities, although multiple randomized trials are currently accruing. Yet, early results from the randomized phase III study of HYPOfractionated RadioTherapy of intermediate risk localized Prostate Cancer (HYPO-RT-PC) trial, as well as multiple single-arm phase I/II trials, indicate low rates of late adverse effects with this approach. In patients with low- to intermediate-risk disease, excellent biochemical relapse-free survival outcomes have been reported, albeit with relatively short median follow-up times. These promising early results, coupled with the enormous potential cost savings and implications for resource availability, suggest that stereotactic body radiotherapy will take center stage in the treatment of prostate cancer in the years to come.
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Affiliation(s)
- Gargi Kothari
- Royal Marsden NHS Foundation Trust, London, United Kingdom
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Alison C. Tree
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Drew Moghanaki
- Hunter Holmes McGuire VA Medical Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Simon S. Lo
- University of Washington School of Medicine, Seattle, WA, USA
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
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