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Gong W, Yao Y, Ni J, Jiang H, Jia L, Xiong W, Zhang W, He S, Wei Z, Zhou J. Deep learning-based low-dose CT for adaptive radiotherapy of abdominal and pelvic tumors. Front Oncol 2022; 12:968537. [PMID: 36059630 PMCID: PMC9436420 DOI: 10.3389/fonc.2022.968537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/28/2022] [Indexed: 11/15/2022] Open
Abstract
The shape and position of abdominal and pelvic organs change greatly during radiotherapy, so image-guided radiation therapy (IGRT) is urgently needed. The world’s first integrated CT-linac platform, equipped with fan beam CT (FBCT), can provide a diagnostic-quality FBCT for achieve adaptive radiotherapy (ART). However, CT scans will bring the risk of excessive scanning radiation dose. Reducing the tube current of the FBCT system can reduce the scanning dose, but it will lead to serious noise and artifacts in the reconstructed images. In this study, we proposed a deep learning method, Content-Noise Cycle-Consistent Generative Adversarial Network (CNCycle-GAN), to improve the image quality and CT value accuracy of low-dose FBCT images to meet the requirements of adaptive radiotherapy. We selected 76 patients with abdominal and pelvic tumors who received radiation therapy. The patients received one low-dose CT scan and one normal-dose CT scan in IGRT mode during different fractions of radiotherapy. The normal dose CT images (NDCT) and low dose CT images (LDCT) of 70 patients were used for network training, and the remaining 6 patients were used to validate the performance of the network. The quality of low-dose CT images after network restoration (RCT) were evaluated in three aspects: image quality, automatic delineation performance and dose calculation accuracy. Taking NDCT images as a reference, RCT images reduced MAE from 34.34 ± 5.91 to 20.25 ± 4.27, PSNR increased from 34.08 ± 1.49 to 37.23 ± 2.63, and SSIM increased from 0.92 ± 0.08 to 0.94 ± 0.07. The P value is less than 0.01 of the above performance indicators indicated that the difference were statistically significant. The Dice similarity coefficients (DCS) between the automatic delineation results of organs at risk such as bladder, femoral heads, and rectum on RCT and the results of manual delineation by doctors both reached 0.98. In terms of dose calculation accuracy, compared with the automatic planning based on LDCT, the difference in dose distribution between the automatic planning based on RCT and the automatic planning based on NDCT were smaller. Therefore, based on the integrated CT-linac platform, combined with deep learning technology, it provides clinical feasibility for the realization of low-dose FBCT adaptive radiotherapy for abdominal and pelvic tumors.
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Affiliation(s)
- Wei Gong
- Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiming Yao
- Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jie Ni
- Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hua Jiang
- Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lecheng Jia
- Real Time Laboratory, Shenzhen United Imaging Research Institute of Innovative Medical Equipment, Shenzhen, China
| | - Weiqi Xiong
- Radiotherapy Business Unit, Shanghai United Imaging Healthcare Co., Ltd., Shanghai, China
| | - Wei Zhang
- Radiotherapy Business Unit, Shanghai United Imaging Healthcare Co., Ltd., Shanghai, China
| | - Shumeng He
- IRT Laboratory, United Imaging Research Institute of Intelligent Imaging, Beijing, China
| | - Ziquan Wei
- Real Time Laboratory, Shenzhen United Imaging Research Institute of Innovative Medical Equipment, Shenzhen, China
- *Correspondence: Ziquan Wei, ; Juying Zhou,
| | - Juying Zhou
- Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Ziquan Wei, ; Juying Zhou,
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Russo S, Ricotti R, Molinelli S, Patti F, Barcellini A, Mastella E, Pella A, Paganelli C, Marvaso G, Pepa M, Comi S, Zaffaroni M, Avuzzi B, Giandini T, Pignoli E, Valdagni R, Baroni G, Cattani F, Ciocca M, Jereczek-Fossa BA, Orlandi E, Orecchia R, Vischioni B. Dosimetric Impact of Inter-Fraction Anatomical Changes in Carbon Ion Boost Treatment for High-Risk Prostate Cancer (AIRC IG 14300). Front Oncol 2021; 11:740661. [PMID: 34650922 PMCID: PMC8506150 DOI: 10.3389/fonc.2021.740661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/06/2021] [Indexed: 02/04/2023] Open
Abstract
Rectum and bladder volumes play an important role in the dose distribution reproducibility in prostate cancer adenocarcinoma (PCa) radiotherapy, especially for particle therapy, where density variation can strongly affect the dose distribution. We investigated the reliability and reproducibility of our image-guided radiotherapy (IGRT) and treatment planning protocol for carbon ion radiotherapy (CIRT) within the phase II mixed beam study (AIRC IG 14300) for the treatment of high-risk PCa. In order to calculate the daily dose distribution, a set of synthetic computed tomography (sCT) images was generated from the cone beam computed tomography (CBCT) images acquired in each treatment session. Planning target volume (PTV) together with rectum and bladder volume variation was evaluated with sCT dose-volume histogram (DVH) metric deviations from the planning values. The correlations between the bladder and rectum volumes, and the corresponding DVH metrics, were also assessed. No significant difference in the bladder, rectum, and PTV median volumes between the planning computed tomography (pCT) and the sCT was found. In addition, no significant difference was assessed when comparing the average DVHs and median DVH metrics between pCT and sCT. Dose deviations determined by bladder and rectum filling variations demonstrated that dose distributions were reproducible in terms of both target coverage and organs at risk (OARs) sparing.
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Affiliation(s)
- Stefania Russo
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Rosalinda Ricotti
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Silvia Molinelli
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Filippo Patti
- Radiotherapy Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.,Division of Radiotherapy, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Amelia Barcellini
- Radiotherapy Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Edoardo Mastella
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Andrea Pella
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giulia Marvaso
- Division of Radiotherapy, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Matteo Pepa
- Division of Radiotherapy, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefania Comi
- Medical Physics Unit, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiotherapy, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Barbara Avuzzi
- Department of Radiation Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Tommaso Giandini
- Medical Physics Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuele Pignoli
- Medical Physics Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Valdagni
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Medical Physics Unit, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Guido Baroni
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Federica Cattani
- Medical Physics Unit, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mario Ciocca
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Ester Orlandi
- Radiotherapy Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Barbara Vischioni
- Radiotherapy Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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Da Silva Mendes V, Nierer L, Li M, Corradini S, Reiner M, Kamp F, Niyazi M, Kurz C, Landry G, Belka C. Dosimetric comparison of MR-linac-based IMRT and conventional VMAT treatment plans for prostate cancer. Radiat Oncol 2021; 16:133. [PMID: 34289868 PMCID: PMC8296626 DOI: 10.1186/s13014-021-01858-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/12/2021] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this study was to evaluate and compare the performance of intensity modulated radiation therapy (IMRT) plans, planned for low-field strength magnetic resonance (MR) guided linear accelerator (linac) delivery (labelled IMRT MRL plans), and clinical conventional volumetric modulated arc therapy (VMAT) plans, for the treatment of prostate cancer (PCa). Both plans used the original planning target volume (PTV) margins. Additionally, the potential dosimetric benefits of MR-guidance were estimated, by creating IMRT MRL plans using smaller PTV margins. Materials and methods 20 PCa patients previously treated with conventional VMAT were considered. For each patient, two different IMRT MRL plans using the low-field MR-linac treatment planning system were created: one with original (orig.) PTV margins and the other with reduced (red.) PTV margins. Dose indices related to target coverage, as well as dose-volume histogram (DVH) parameters for the target and organs at risk (OAR) were compared. Additionally, the estimated treatment delivery times and the number of monitor units (MU) of each plan were evaluated. Results The dose distribution in the high dose region and the target volume DVH parameters (D98%, D50%, D2% and V95%) were similar for all three types of treatment plans, with deviations below 1% in most cases. Both IMRT MRL plans (orig. and red. PTV margins) showed similar homogeneity indices (HI), however worse values for the conformity index (CI) were also found when compared to VMAT. The IMRT MRL plans showed similar OAR sparing when the orig. PTV margins were used but a significantly better sparing was feasible when red. PTV margins were applied. Higher number of MU and longer predicted treatment delivery times were seen for both IMRT MRL plans. Conclusions A comparable plan quality between VMAT and IMRT MRL plans was achieved, when applying the same PTV margin. However, online MR-guided adaptive radiotherapy allows for a reduction of PTV margins. With a red. PTV margin, better sparing of the surrounding tissues can be achieved, while maintaining adequate target coverage. Nonetheless, longer treatment delivery times, characteristic for the IMRT technique, have to be expected.
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Affiliation(s)
- Vanessa Da Silva Mendes
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Lukas Nierer
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Florian Kamp
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.,Department of Radiation Oncology, Cologne University Hospital, Cologne, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
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Sun H, Lu Z, Fan R, Xiong W, Xie K, Ni X, Yang J. Research on obtaining pseudo CT images based on stacked generative adversarial network. Quant Imaging Med Surg 2021; 11:1983-2000. [PMID: 33936980 DOI: 10.21037/qims-20-1019] [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] [Indexed: 11/06/2022]
Abstract
Background To investigate the feasibility of using a stacked generative adversarial network (sGAN) to synthesize pseudo computed tomography (CT) images based on ultrasound (US) images. Methods The pre-radiotherapy US and CT images of 75 patients with cervical cancer were selected for the training set of pseudo-image synthesis. In the first stage, labeled US images were used as the first conditional GAN input to obtain low-resolution pseudo CT images, and in the second stage, a super-resolution reconstruction GAN was used. The pseudo CT image obtained in the first stage was used as an input, following which a high-resolution pseudo CT image with clear texture and accurate grayscale information was obtained. Five cross validation tests were performed to verify our model. The mean absolute error (MAE) was used to compare each pseudo CT with the same patient's real CT image. Also, another 10 cases of patients with cervical cancer, before radiotherapy, were selected for testing, and the pseudo CT image obtained using the neural style transfer (NSF) and CycleGAN methods were compared with that obtained using the sGAN method proposed in this study. Finally, the dosimetric accuracy of pseudo CT images was verified by phantom experiments. Results The MAE metric values between the pseudo CT obtained based on sGAN, and the real CT in five-fold cross validation are 66.82±1.59 HU, 66.36±1.85 HU, 67.26±2.37 HU, 66.34±1.75 HU, and 67.22±1.30 HU, respectively. The results of the metrics, namely, normalized mutual information (NMI), structural similarity index (SSIM), and peak signal-to-noise ratio (PSNR), between the pseudo CT images obtained using the sGAN method and the ground truth CT (CTgt) images were compared with those of the other two methods via the paired t-test, and the differences were statistically significant. The dice similarity coefficient (DSC) measurement results showed that the pseudo CT images obtained using the sGAN method were more similar to the CTgt images of organs at risk. The dosimetric phantom experiments also showed that the dose distribution between the pseudo CT images synthesized by the new method was similar to that of the CTgt images. Conclusions Compared with NSF and CycleGAN methods, the sGAN method can obtain more accurate pseudo CT images, thereby providing a new method for image guidance in radiotherapy for cervical cancer.
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Affiliation(s)
- Hongfei Sun
- School of Automation, Northwestern Polytechnical University, Xi'an, China
| | - Zhengda Lu
- Department of Radiotherapy, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, China.,The Center of Medical Physics, Nanjing Medical University, Changzhou, China.,The Key Laboratory of Medical Physics, Changzhou, China
| | - Rongbo Fan
- School of Automation, Northwestern Polytechnical University, Xi'an, China
| | - Wenjun Xiong
- School of Automation, Northwestern Polytechnical University, Xi'an, China
| | - Kai Xie
- Department of Radiotherapy, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, China.,The Center of Medical Physics, Nanjing Medical University, Changzhou, China.,The Key Laboratory of Medical Physics, Changzhou, China
| | - Xinye Ni
- Department of Radiotherapy, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, China.,The Center of Medical Physics, Nanjing Medical University, Changzhou, China.,The Key Laboratory of Medical Physics, Changzhou, China
| | - Jianhua Yang
- School of Automation, Northwestern Polytechnical University, Xi'an, China
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Sun H, Yang J, Fan R, Xie K, Wang C, Ni X. Stepwise local stitching ultrasound image algorithms based on adaptive iterative threshold Harris corner features. Medicine (Baltimore) 2020; 99:e22189. [PMID: 32925793 PMCID: PMC7489749 DOI: 10.1097/md.0000000000022189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Herein, a Harris corner detection algorithm is proposed based on the concepts of iterated threshold segmentation and adaptive iterative threshold (AIT-Harris), and a stepwise local stitching algorithm is used to obtain wide-field ultrasound (US) images.Cone-beam computer tomography (CBCT) and US images from 9 cervical cancer patients and 1 prostate cancer patient were examined. In the experiment, corner features were extracted based on the AIT-Harris, Harris, and Morave algorithms. Accordingly, wide-field ultrasonic images were obtained based on the extracted features after local stitching, and the corner matching rates of all tested algorithms were compared. The accuracies of the drawn contours of organs at risk (OARs) were compared based on the stitched ultrasonic images and CBCT.The corner matching rate of the Morave algorithm was compared with those obtained by the Harris and AIT-Harris algorithms, and paired sample t tests were conducted (t = 6.142, t = 31.859, P < .05). The results showed that the differences were statistically significant. The average Dice similarity coefficient between the automatically delineated bladder region based on wide-field US images and the manually delineated bladder region based on ground truth CBCT images was 0.924, and the average Jaccard coefficient was 0.894.The proposed algorithm improved the accuracy of corner detection, and the stitched wide-field US image could modify the delineation range of OARs in the pelvic cavity.
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Affiliation(s)
- Hongfei Sun
- School of Automation, Northwestern Polytechnical University, Xi’an, Shanxi
| | - Jianhua Yang
- School of Automation, Northwestern Polytechnical University, Xi’an, Shanxi
| | - Rongbo Fan
- School of Automation, Northwestern Polytechnical University, Xi’an, Shanxi
| | - Kai Xie
- Second People's Hospital of Changzhou, Nanjing Medical University
- The center of medical physics with Nanjing Medical University
- The key laboratory of medical physics with Changzhou, Changzhou, China
| | - Conghui Wang
- School of Automation, Northwestern Polytechnical University, Xi’an, Shanxi
| | - Xinye Ni
- Second People's Hospital of Changzhou, Nanjing Medical University
- The center of medical physics with Nanjing Medical University
- The key laboratory of medical physics with Changzhou, Changzhou, China
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Gorovets D, Burleson S, Jacobs L, Ravindranath B, Tierney K, Kollmeier M, McBride S, Happersett L, Hunt M, Zelefsky M. Prostate SBRT With Intrafraction Motion Management Using a Novel Linear Accelerator-Based MV-kV Imaging Method. Pract Radiat Oncol 2020; 10:e388-e396. [PMID: 32454176 DOI: 10.1016/j.prro.2020.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/19/2020] [Accepted: 04/24/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE This study reports clinical experience using a linear accelerator-based MV-kV imaging system for intrafraction motion management during prostate stereotactic body radiation therapy (SBRT). METHODS AND MATERIALS From June 2016 to August 2018, 193 prostate SBRT patients were treated using MV-kV motion management (median dose 40 Gy in 5 fractions). Patients had 3 fiducials implanted then simulated and treated with a full bladder and empty rectum. Pretreatment orthogonal kVs and cone beam computed tomography were used to position patients and evaluate internal anatomy. Motion was tracked during volumetric modulated arc therapy delivery using simultaneously acquired kV and MV images from standard on-board systems. Treatment was interrupted to reposition patients when motion >1.5-2 mm was detected. Motion traces were analyzed and compared with Calypso traces from a previously treated similar patient cohort. To evaluate "natural motion" (ie, if we had not interrupted treatment and repositioned), intrafraction couch corrections were removed from all traces. Clinical effectiveness of the MV-kV system was explored by evaluating toxicity (Common Terminology Criteria for Adverse Events v3.0) and biochemical recurrence rates (nadir + 2 ng/mL). RESULTS Median number of interruptions for patient repositioning was 1 per fraction (range, 0-9). Median overall treatment time was 8.2 minutes (range, 4.2-44.8 minutes). Predominant motion was inferior and posterior, and probability of motion increased with time. Natural motion >3 mm and >5 mm in any direction was observed in 32.3% and 10.2% of fractions, respectively. Calypso monitoring (n = 50) demonstrated similar motion results. In the 151 MV-kV patients with ≥3-month follow-up (median, 9.5 months; range, 3-26.5 months), grade ≥2 acute genitourinary/gastrointestinal and late genitourinary/gastrointestinal toxicity was observed in 9.9%/2.0% and 11.9%/2.7%, respectively. Biochemical control was 99.3% with a single failure in a high-risk patient. CONCLUSIONS The MV-kV system is an effective method to manage intrafraction prostate motion during SBRT, offering the opportunity to correct for prostate clinical target volume displacements that would have otherwise extended beyond typical planning target volume margins.
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Affiliation(s)
- Daniel Gorovets
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Sarah Burleson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lauren Jacobs
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bosky Ravindranath
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kevin Tierney
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marisa Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laura Happersett
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Margie Hunt
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Schlüter M, Fürweger C, Schlaefer A. Optimizing robot motion for robotic ultrasound-guided radiation therapy. ACTA ACUST UNITED AC 2019; 64:195012. [DOI: 10.1088/1361-6560/ab3bfb] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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8
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Zhou S, Luo L, Li J, Lin M, Chen L, Shao J, Lu S, Ma Y, Zhang Y, Chen W, Liu M, Liu S, He L. Analyses of the factors influencing the accuracy of three-dimensional ultrasound in comparison with cone-beam CT in image-guided radiotherapy for prostate cancer with or without pelvic lymph node irradiation. Radiat Oncol 2019; 14:22. [PMID: 30696488 PMCID: PMC6352439 DOI: 10.1186/s13014-019-1217-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/08/2019] [Indexed: 11/16/2022] Open
Abstract
Background Three-dimensional ultrasound (3DUS) is an attractive option in image-guided radiotherapy (IGRT) for prostate cancer (PCa) patients. However, the potential factors influencing the accuracy of 3DUS in comparison with cone-beam CT (CBCT) in IGRT for PCa patients haven’t been clearly identified. Methods The differences between US/US and CBCT/CT registrations were analyzed over 586 and 580 sessions for 24 and 25 PCa patients treated with or without pelvic lymph node irradiation, respectively. The clinical factors that may influence registration differences were also evaluated. Results The average discrepancies between US/US and CBCT/CT registrations were − 0.28 ± 5.28 mm, − 0.16 ± 3.48 mm, and − 0.47 ± 4.31 mm in the superior-inferior (SI), left-right (LR), and anterior-posterior (AP) directions, respectively. The discrepancies were respectively less than 5 mm longitudinally, laterally, and vertically in 64.4 and 70.1%, 84.9 and 89.2%, and 75.9 and 79.1% of the patients treated with or without pelvic lymph node irradiation, respectively. The registration differences were significantly smaller at least in one direction in patients younger than 70 years, without pelvic lymph node irradiation, guided by transperineal ultrasonography and had a bladder volume smaller than 300 mL. Conclusions Age, irradiated regions, 3DUS modality, and bladder volume are important factors that may influence the differences between US/US and CBCT/CT registrations. 3DUS guidance is more feasible for younger PCa patients with a better control of bladder volume during the treatment and those who did not undergo pelvic lymph node irradiation. Electronic supplementary material The online version of this article (10.1186/s13014-019-1217-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sha Zhou
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Liling Luo
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Jibin Li
- Department of Clinical Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Maosheng Lin
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Li Chen
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Jianhui Shao
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Shipei Lu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Yaru Ma
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Yingting Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Wenfen Chen
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Mengzhong Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China
| | - Shiliang Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China.
| | - Liru He
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, Dongfeng Road East, Guangzhou, 510060, China.
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Imaging study of pseudo-CT images of superposed ultrasound deformation fields acquired in radiotherapy based on step-by-step local registration. Med Biol Eng Comput 2018; 57:643-651. [DOI: 10.1007/s11517-018-1912-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
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10
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Kim H, Chang AR, Cho S, Ye SJ. A patient-specific three-dimensional couplant pad for ultrasound image-guided radiation therapy: a feasibility study. Radiat Oncol 2018; 13:164. [PMID: 30176924 PMCID: PMC6122664 DOI: 10.1186/s13014-018-1098-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 08/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A wide application of ultrasound for radiation therapy has been hindered by a few issues such as skin and target deformations due to probe pressure, optical tracking disabilities caused by irregular surfaces and inter-user variations. The purpose of this study was to overcome these barriers by using a patient-specific three-dimensional (3D) couplant pad (CP). METHODS A patient skin mold was designed using a skin contour of simulation CT images and fabricated by a 3D printer. A CP was then casted by pouring gelatin solution into a container accommodating the mold. To validate the use of the CP in positioning accuracy and imaging quality, phantom tests were carried out in our ultrasound-based localization system and then daily ultrasound images of four patients were acquired with and without the CP before treatment. RESULTS In the phantom study, the use of CP increased a contrast-to-noise ratio from 2.4 to 4.0. The positioning accuracies in the US scans with and without the CP were less than 1 mm in all directions. In the patient study, the use of CP decreased the centroid offset of the target volume after target position alignment from 4.4 mm to 2.9 mm. One patient with a small volume of target showed a substantial increase in the inter-fractional target contour agreement (from 0.07 (poor agreement) to 0.31 (fair agreement) in Kappa values) by using the CP. CONCLUSIONS Our patient-specific 3D CP based on a 3D mold printing technique not only maintained the tracking accuracy but also reduced the inter-user variation, as well as that could potentially improve detectability of optical markers and target visibility for ultrasound image-guided radiotherapy.
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Affiliation(s)
- Heejung Kim
- Department of Biomedical Engineering, Seoul National University, Seoul, Korea.,Department of Radiation Oncology, Soonchunhyang University Hospital, Seoul, Korea
| | - Ah Ram Chang
- Department of Radiation Oncology, Soonchunhyang University Hospital, Seoul, Korea
| | - Sungwoo Cho
- Department of Surgery, Soonchunhyang University Hospital, Seoul, Korea
| | - Sung-Joon Ye
- Department of Transdisciplinary Studies, Seoul National University, Seoul, Korea. .,Advanced Institutes of Convergence Technology, Seoul National University, Suwon, Korea. .,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
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11
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Sun H, Xie K, Gao L, Sui J, Lin T, Ni X. Research on pseudo-CT imaging technique based on an ultrasound deformation field with binary mask in radiotherapy. Medicine (Baltimore) 2018; 97:e12532. [PMID: 30235776 PMCID: PMC6160174 DOI: 10.1097/md.0000000000012532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022] Open
Abstract
This study aimed to investigate the reliability of pseudo-computed tomography (pseudo-CT) imaging based on ultrasound (US) deformation fields under different binary masks in radiotherapy.We used 3-dimensional (3D) CT and US images, including those acquired during CT simulation positioning, and cone-beam CT (CBCT) and US images acquired 1 week after treating 3 patients with cervical cancer. Image data of 3 different layers were selected from the US images, and 3D CT images of each patient were selected. For US image registration, the following were created and applied: binary masks of the region of interest overlapping (ROIO) between the US image based on simulation positioning and US image for positioning verification, region of interest (ROI), whole overlapping (wholeO), and whole imaging region (whole). Accordingly, the deformation field was obtained and applied to CT images (CTsim), and different pseudo-CT images were acquired. Similarities between the pseudo-CT and CBCT images were compared, and registration accuracies between pseudo-CT images under different binary masks and CTsim were compared and discussed.A pair t test was conducted to normalized mutual information values of the registration accuracy between the pseudo-CT image based on ROIO binary mask and CTsim with other methods (P < .05), and the difference was statistically significant. A pair t test of normalized gray mean-squared errors was also performed (P < .05), and the difference was statistically significant. The similarity function means between pseudo-CT, that is, based on ROIO, ROI, wholeO, whole, and no binary mask, and CBCT were 0.9084, 0.8365, 0.7800, 0.6830, and 0.5518, respectively.Pseudo-CT based on ROIO binary mask best matched with CTsim and achieved the highest similarity with CBCT.
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Affiliation(s)
- Hongfei Sun
- The Affiliated Changzhou No. 2, People's Hospital of Nanjing Medical University
- The Center of Medical Physics with Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Kai Xie
- The Affiliated Changzhou No. 2, People's Hospital of Nanjing Medical University
- The Center of Medical Physics with Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Liugang Gao
- The Affiliated Changzhou No. 2, People's Hospital of Nanjing Medical University
- The Center of Medical Physics with Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Jianfeng Sui
- The Affiliated Changzhou No. 2, People's Hospital of Nanjing Medical University
- The Center of Medical Physics with Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Tao Lin
- The Affiliated Changzhou No. 2, People's Hospital of Nanjing Medical University
- The Center of Medical Physics with Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Xinye Ni
- The Affiliated Changzhou No. 2, People's Hospital of Nanjing Medical University
- The Center of Medical Physics with Nanjing Medical University, Changzhou, Jiangsu Province, China
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12
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The Use of Ultrasound Imaging in the External Beam Radiotherapy Workflow of Prostate Cancer Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7569590. [PMID: 29619375 PMCID: PMC5829356 DOI: 10.1155/2018/7569590] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/13/2017] [Accepted: 12/28/2017] [Indexed: 12/16/2022]
Abstract
External beam radiotherapy (EBRT) is one of the curative treatment options for prostate cancer patients. The aim of this treatment option is to irradiate tumor tissue, while sparing normal tissue as much as possible. Frequent imaging during the course of the treatment (image guided radiotherapy) allows for determination of the location and shape of the prostate (target) and of the organs at risk. This information is used to increase accuracy in radiation dose delivery resulting in better tumor control and lower toxicity. Ultrasound imaging is harmless for the patient, it is cost-effective, and it allows for real-time volumetric organ tracking. For these reasons, it is an ideal technique for image guidance during EBRT workflows. Review papers have been published in which the use of ultrasound imaging in EBRT workflows for different cancer sites (prostate, breast, etc.) was extensively covered. This new review paper aims at providing the readers with an update on the current status for prostate cancer ultrasound guided EBRT treatments.
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13
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Richardson A, Jacobs P. Intrafraction monitoring of prostate motion during radiotherapy using the Clarity ® Autoscan Transperineal Ultrasound (TPUS) system. Radiography (Lond) 2017; 23:310-313. [DOI: 10.1016/j.radi.2017.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/13/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
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14
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Yu AS, Najafi M, Hristov DH, Phillips T. Intrafractional Tracking Accuracy of a Transperineal Ultrasound Image Guidance System for Prostate Radiotherapy. Technol Cancer Res Treat 2017; 16:1067-1078. [PMID: 29332454 PMCID: PMC5762073 DOI: 10.1177/1533034617728643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the tracking accuracy of a commercial ultrasound system under relevant treatment conditions and demonstrate its clinical utility for detecting significant treatment deviations arising from inadvertent intrafractional target motion. METHODS A multimodality male pelvic phantom was used to simulate prostate image-guided radiotherapy with the system under evaluation. Target motion was simulated by placing the phantom on a motion platform. The tracking accuracy of the ultrasound system was evaluated using an independent optical tracking system under the conditions of beam-on, beam-off, poor image quality with an acoustic shadow introduced, and different phantom motion cycles. The time delay between the ultrasound-detected and actual phantom motion was investigated. A clinical case example of prostate treatment is presented as a demonstration of the utility of the system in practice. RESULTS Time delay between the motion phantom and ultrasound tracking system is 223 ± 45.2 milliseconds including video and optical tracking system frame rates. The tracking accuracy and precision were better with a longer period. The precision of ultrasound tracking performance in the axial (superior-inferior) direction was better than that in the lateral (left-right) direction (root mean square errors are 0.18 and 0.25 mm, respectively). The accuracy of ultrasound tracking performance in the lateral direction was better than that in the axial direction (the mean position errors are 0.23 and 0.45 mm, respectively). Interference by radiation and image quality do not affect tracking ability significantly. Further, utilizing the tracking system as part of a clinical study for prostate treatment further verified the accuracy and clinical appropriateness. CONCLUSIONS It is feasible to use transperineal ultrasound daily to monitor prostate motion during treatment. Our results verify the accuracy and precision of an ultrasound system under typical external beam treatment conditions and further demonstrate that the tracking system was able to identify important prostate shifts in a clinical case.
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Affiliation(s)
- Amy S Yu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Mohammad Najafi
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Dimitre H Hristov
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Tiffany Phillips
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
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15
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Li M, Hegemann NS, Manapov F, Kolberg A, Thum PD, Ganswindt U, Belka C, Ballhausen H. Prefraction displacement and intrafraction drift of the prostate due to perineal ultrasound probe pressure. Strahlenther Onkol 2017; 193:459-465. [DOI: 10.1007/s00066-017-1105-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
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16
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Three-dimensional surface and ultrasound imaging for daily IGRT of prostate cancer. Radiat Oncol 2016; 11:159. [PMID: 27955693 PMCID: PMC5154119 DOI: 10.1186/s13014-016-0734-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Image guided radiotherapy (IGRT) is an essential pre-requisite for delivering high precision radiotherapy. We compared daily variation detected by two non-ionizing imaging modalities (surface imaging and trans-abdominal ultrasound, US) to verify prostate patient setup and internal organ variations. Methods Forty patients with organ confined prostate cancer and candidates to curative radiotherapy were enrolled in this prospective study. At each treatment session, after laser alignment, all patients received imaging by a 3D-surface and a 3D-US system. The shifts along the three directions (anterior-posterior AP, cranial-caudal CC, and later-lateral LL) were measured in terms of systematic and random errors. Then, we performed statistical analysis on the differences and the possible correlations between the two modalities. Results For both IGRT modalities, surface imaging and US, 1318 acquisitions were collected. According with Shapiro Wilk test, the positioning error distributions were not Gaussian for both modalities. The differences between the systematic errors detected by the two modalities were statistically significant only in LL direction (p < 0.05), while the differences between the random errors were not statistically significant in any directions. The 95% confidence interval of the residual errors obtained by subtracting the random errors detected with surface images to those detected with US was included in the range from −7 mm to 7 mm corresponding to the minimum PTV margin adopted in AP direction in our clinical routine. Conclusions From our data, it emerges that setup misalignments measured by surface imaging can be predictive of US displacements after the adjustment for systematic errors. Moreover, surface imaging can detect setup errors predictive of registration errors measured by US. This data suggest that the two IGRT modalities could be considered as complementary to each other and could represent a daily “low-cost” and non-invasive IGRT modality in prostate cancer patients.
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17
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Comparison of prostate positioning guided by three-dimensional transperineal ultrasound and cone beam CT. Strahlenther Onkol 2016; 193:221-228. [PMID: 27928626 DOI: 10.1007/s00066-016-1084-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 11/09/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The accuracy of a transperineal three-dimensional ultrasound system (3DUS) was assessed for prostate positioning and compared to fiducial- and bone-based positioning in kV cone beam computed tomography (CBCT) during definitive radiotherapy of prostate cancer. METHODS Each of the 7 patients had three fiducial markers implanted into the prostate before treatment. Prostate positioning was simultaneously measured by 3DUS and CBCT before each fraction. In total, 177 pairs of 3DUS and CBCT scans were collected. Bone-match and seed-match were performed for each CBCT. Using seed-match as a reference, the accuracy of 3DUS and bone-match was evaluated. Systematic and random errors as well as optimal setup margins were calculated for 3DUS and bone-match. RESULTS The discrepancy between 3DUS and seed-match in CBCT (average ± standard deviation) was 0.0 ± 1.7 mm laterally, 0.2 ± 2.0 mm longitudinally, and 0.3 ± 1.7 mm vertically. Using seed-match as a reference, systematic errors for 3DUS were 1.2 mm, 1.1 mm, and 0.9 mm; and random errors were 1.4 mm, 1.8 mm, and 1.6 mm, on lateral, longitudinal, and vertical axes, respectively. By analogy, the difference of bone-match to seed-match was 0.1 ± 1.1 mm laterally, 1.3 ± 3.8 mm longitudinally, and 1.3 ± 4.5 mm vertically. Systematic errors were 0.5 mm, 2.2 mm, and 2.6 mm; and random errors were 1.0 mm, 3.1 mm, and 3.9 mm on lateral, longitudinal, and vertical axes, respectively. The accuracy of 3DUS was significantly higher than that of bone-match on longitudinal and vertical axes, but not on the lateral axis. CONCLUSION Image-guided radiotherapy of prostate cancer based on transperineal 3DUS was feasible, with overall small discrepancy to seed-match in CBCT in this retrospective study. Compared to bone-match, transperineal 3DUS achieved higher accuracy on longitudinal and vertical axes.
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18
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Walter F, Freislederer P, Belka C, Heinz C, Söhn M, Roeder F. Evaluation of daily patient positioning for radiotherapy with a commercial 3D surface-imaging system (Catalyst™). Radiat Oncol 2016; 11:154. [PMID: 27881158 PMCID: PMC5122202 DOI: 10.1186/s13014-016-0728-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022] Open
Abstract
Background To report our initial clinical experience with the novel surface imaging system Catalyst™ (C-RAD AB, Sweden) in connection with an Elekta Synergy linear accelerator for daily patient positioning in patients undergoing radiation therapy. Methods We retrospectively analyzed the patient positioning of 154 fractions in 25 patients applied to thoracic, abdominal, and pelvic body regions. Patients were routinely positioned based on skin marks, shifted to the calculated isocenter position and treated after correction via cone beam CT which served as gold standard. Prior to CBCT an additional surface scan by the Catalyst™ system was performed and compared to a reference surface image cropped from the planning CT to obtain shift vectors for an optimal surface match. These shift vectors were subtracted from the vectors obtained by CBCT correction to assess the theoretical setup error that would have occurred if the patients had been positioned using solely the Catalyst™ system. The mean theoretical set up-error and its standard deviation were calculated for all measured fractions and the results were compared to patient positioning based on skin marks only. Results Integration of the surface scan into the clinical workflow did not result in a significant time delay. Regarding the entire group, the mean setup error by using skin marks only was 0.0 ± 2.1 mm in lateral, −0.4 ± 2.4 mm in longitudinal, and 1.1 ± 2.6 mm vertical direction. The mean theoretical setup error that would have occurred using solely the Catalyst™ was −0.1 ± 2.1 mm laterally, −1.8 ± 5.4 mm longitudinally, and 1.4 ± 3.2 mm vertically. No significant difference was found in any direction. For thoracic targets the mean setup error based on the Catalyst™ was 0.6 ± 2.6 mm laterally, −5.0 ± 7.9 mm longitudinally, and 0.5 ± 3.2 mm vertically. For abdominal targets, the mean setup error was 0.3 ± 2.2 mm laterally, 2.6 ± 1.8 mm longitudinally, and 2.1 ± 5.5 mm vertically. For pelvic targets, the setup error was −0.9 ± 1.5 mm laterally, −1.7 ± 2.8 mm longitudinally, and 1.6 ± 2.2 mm vertically. A significant difference between Catalyst™ and skin mark based positioning was only observed in longitudinal direction of pelvic targets. Conclusion Optical surface scanning using Catalyst™ seems potentially useful for daily positioning at least to complement usual imaging modalities in most patients with acceptable accuracy, although a significant improvement compared to skin mark based positioning could not be derived from the evaluated data. However, this effect seemed to be rather caused by the unexpected high accuracy of skin mark based positioning than by inaccuracy using the Catalyst™. Further on, surface registration in longitudinal axis seemed less reliable especially in pelvic localization. Therefore further prospective evaluation based on strictly predefined protocols is needed to determine the optimal scanning approaches and parameters.
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Affiliation(s)
- F Walter
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr 15, 81377, Munich, Germany.
| | - P Freislederer
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - C Belka
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - C Heinz
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - M Söhn
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - F Roeder
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr 15, 81377, Munich, Germany.,Department of Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Richter A, Polat B, Lawrenz I, Weick S, Sauer O, Flentje M, Mantel F. Initial results for patient setup verification using transperineal ultrasound and cone beam CT in external beam radiation therapy of prostate cancer. Radiat Oncol 2016; 11:147. [PMID: 27825386 PMCID: PMC5101794 DOI: 10.1186/s13014-016-0722-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluation of set up error detection by a transperineal ultrasound in comparison with a cone beam CT (CBCT) based system in external beam radiation therapy (EBRT) of prostate cancer. METHODS Setup verification was performed with transperineal ultrasound (TPUS) and CBCT for 10 patients treated with EBRT for prostate cancer. In total, 150 ultrasound and CBCT scans were acquired in rapid succession and analyzed for setup errors. The deviation between setup errors of the two modalities was evaluated separately for each dimension. RESULTS A moderate correlation in lateral, vertical and longitudinal direction was observed comparing the setup errors. Mean differences between TPUS and CBCT were (-2.7 ± 2.3) mm, (3.0 ± 2.4) mm and (3.2 ± 2.7) mm in lateral, vertical and longitudinal direction, respectively. The mean Euclidean difference between TPUS and CBCT was (6.0 ± 3.1) mm. Differences up to 19.2 mm were observed between the two imaging modalities. Discrepancies between TPUS and CBCT of at least 5 mm occurred in 58 % of monitored treatment sessions. CONCLUSION Setup differences between TPUS and CBCT are 6 mm on average. Although the correlation of the setup errors determined by the two different image modalities is rather week, the combination of setup verification by CBCT and intrafraction motion monitoring by TPUS imaging can use the benefits of both imaging modalities.
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Affiliation(s)
- Anne Richter
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany.
| | - Bülent Polat
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Ingulf Lawrenz
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Stefan Weick
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Otto Sauer
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Frederick Mantel
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
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20
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Trivedi A, Ashikaga T, Hard D, Archambault J, Lachaine M, Cooper DT, Wallace HJ. Development of 3-dimensional transperineal ultrasound for image guided radiation therapy of the prostate: Early evaluations of feasibility and use for inter- and intrafractional prostate localization. Pract Radiat Oncol 2016; 7:e27-e33. [PMID: 27742558 DOI: 10.1016/j.prro.2016.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 08/05/2016] [Accepted: 08/30/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Transperineal ultrasound (TPUS) allows for continuous imaging of the prostate gland, but the accuracy of TPUS has not been rigorously studied. We determined the feasibility of prostate imaging with TPUS and subsequently compared prostate localization with TPUS and computed tomography (CT). METHODS AND MATERIALS We completed 2 sequential evaluations of TPUS. The feasibility study included 15 men with localized prostate cancer and tested if TPUS adequately imaged the prostate. Image qualities of the prostate and adjacent normal structures were measured. The subsequent study included 17 men who at the time of initial radiation treatment planning and in 3 subsequent sessions had CT and TPUS imaging performed and compared. RESULTS Feasibility of TPUS was confirmed in the first trial. After expected hardware and software modifications were completed, TPUS provided near complete edge definition of the prostate in the final 5 patients in the feasibility trial. The second study allowed for the comparison of 30 image sets. The differences between TPUS and CT in each direction (mean + standard deviation) were found to be 0.06 ± 2.86 mm (anteroposterior), 0.49 ± 3.49 mm (superoinferior), and 0.63 ± 3.27 mm (left-right), with no significant difference between the 2 modalities (all P > .32). The Euclidean distance variance using the 2 techniques was 5.25 ± 1.79 mm, which was significantly different. CONCLUSIONS TPUS provides good imaging of the prostate gland. We noted excellent correlation in gland localization when TPUS is compared with CT scans when comparing routine 3-dimensional positional data. Euclidean distance variation suggests the potential that summation of small errors may in fact lead to significant differences in actual gland positional certainty. The reported difference is within the range of standard planning target volume expansion however requires additional evaluation.
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Affiliation(s)
- Apoorva Trivedi
- Medical student, University of Vermont College of Medicine, Burlington, Vermont
| | - Takamura Ashikaga
- Medical Biostatistics, University of Vermont College of Medicine, Burlington, Vermont
| | - Daphne Hard
- Radiation Oncology, University of Vermont Medical Center, Burlington, Vermont
| | - Jessica Archambault
- Radiation Oncology, University of Vermont Medical Center, Burlington, Vermont
| | | | | | - Harold James Wallace
- Medical Biostatistics, University of Vermont College of Medicine, Burlington, Vermont; University of Vermont Cancer Center, Burlington, Vermont.
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21
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Changes in penile bulb dose when using the Clarity transperineal ultrasound probe: A planning study. Pract Radiat Oncol 2016; 6:e337-e344. [PMID: 27161954 DOI: 10.1016/j.prro.2016.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/01/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The Clarity system allows monitoring of intrafraction target organ movements in external beam radiation therapy of prostate cancer by using transperineal ultrasound. The probe positioning at the perineum could lead to a compression and shift of the penile bulb (PB) toward the high-dose region. Dose to the PB has been reported to be associated with the risk of posttreatment erectile dysfunction. This planning study reports on PB translations and changes in volume and dose when applying the transperineal ultrasound probe. METHODS AND MATERIALS For 10 patients treated with external beam radiation therapy for prostate cancer between 2013 and 2014, a planning computed tomography scan with and without the ultrasound probe in place was acquired. The planning target volume and organs at risk including the PB were contoured in the computed tomography scan with and without the probe. Radiation therapy plans for both scenarios were calculated. In a second step, for planning with the probe in position, an additional objective for improved sparing of the PB was introduced. RESULTS The median PB volume was 5.5 mL (range, 3.8-7.1 mL) without the probe and 3.5 mL (range, 2.0-5.8 mL) with the probe. The median shift of the PB was 1 mm in the posterior (range, 3 mm posterior-2 mm anterior) and 6 mm in the superior direction (range, 0-14 mm superior), with no relevant shift of the prostate. The median mean dose in 95% of the PB was 34.1 Gy (range, 6.0-50.4 Gy), 48.3 Gy (range, 7.2-56.8 Gy), and 39.4 Gy (range, 5.6-51.3 Gy) for plans without probe, with probe, and with probe and additional planning objective, respectively. CONCLUSIONS Dose to the PB increased when using the transperineal probe. After introducing an additional plan-optimization objective for PB sparing, dose-volume parameters were below Quantitative Analyses of Normal Tissue Effects in the Clinic thresholds for all but one patient.
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22
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Ballhausen H, Ganswindt U, Belka C, Li M. Intra-fraction motion of the prostate is not increased by patient couch shifts. Radiat Oncol 2016; 11:49. [PMID: 27005431 PMCID: PMC4804511 DOI: 10.1186/s13014-016-0620-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During a fraction of external beam radiotherapy for prostate cancer, a mismatch between target volume and dose coverage may accumulate over time due to intra-fraction motion. One way to remove the residual error is to perform a couch shift in opposite direction. In principle, such couch shifts could cause secondary displacements of the patient and prostate. Hence it is interesting to investigate if couch shifts might amplify intra-fraction motion. FINDINGS Intra-fraction motion of the prostate and patient couch position were simultaneously recorded during 359 fractions in 15 patients. During this time, a total of 22 couch shifts of up to 31.5 mm along different axes were recorded. Prostate position and couch position were plotted before, during and after each couch shift. There was no visible impact of couch shifts on prostate motion. The standard deviation of prostate position was calculated before, during and after each couch shift. The standard deviation did not significantly increase during couch shifts (by 3 % on average, p = 0.88) and even slightly decreased after a couch shift (by 37 % on average; p = 0.02). CONCLUSIONS Shifts of the patient couch did not adversely affect the motion of the prostate relative to the patient couch. Hence, shifts of the patient couch may be a viable way to correct the position of the prostate relative to the dose distribution.
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Affiliation(s)
- Hendrik Ballhausen
- University Hospital of LMU Munich, Department of Radiation Oncology, Marchioninistraße 15, 81377, Munich, Germany.
| | - Ute Ganswindt
- University Hospital of LMU Munich, Department of Radiation Oncology, Marchioninistraße 15, 81377, Munich, Germany
| | - Claus Belka
- University Hospital of LMU Munich, Department of Radiation Oncology, Marchioninistraße 15, 81377, Munich, Germany
| | - Minglun Li
- University Hospital of LMU Munich, Department of Radiation Oncology, Marchioninistraße 15, 81377, Munich, Germany
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Effect of maxillary expansion on orthodontics. ASIAN PAC J TROP MED 2015; 8:944-951. [PMID: 26614995 DOI: 10.1016/j.apjtm.2015.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 09/20/2015] [Accepted: 09/30/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore the effect of maxillary expansion on orthodontics. METHODS Eight beagle dogs were randomly divided into two groups, with 4 dogs in each group. Dogs in group 1 were executed immediately and received the direct physical measurement. The magnetic expansion appliance was used in group 2 for the maxillary expansion. After the expansion, the model was taken again and they were executed after cone beam CT (CBCT) scanning. The model measurement method was adopted in group 1 to measure the dental measurement indicators and width of base bone arch. The CBCT measurement method was employed to measure the above dental indicators and bone indicators. The difference in the indicators measured by different methods was compared and analyzed. RESULTS Before the expansion, there was no significant difference in the bone measurement indicators between the CBCT measurement method and direct physical measurement method. After the expansion, there was no significant difference in indicators between the CBCT measurement method and direct physical measurement. But there was significant difference among the model measurement method, CBCT measurement method and direct physical measurement method. There was the significant difference in the dental indicators between the CBCT measurement method and model measurement, as well as the bone indicators of posterior marginal spacing of greater palatine foramen, posterior marginal spacing of incisive foramen, width of base bone arch and spacing of implant anchorage. CONCLUSIONS There is no significant difference between the effect of CBCT measurement method and direct physical measurement method, but CBCT is significantly better than the model measurement.
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